@Article{info:doi/10.2196/65986,
author="Murray, M. Regan
and Chiang, C. Shawn
and Klassen, C. Ann
and Manganello, A. Jennifer
and Leader, E. Amy
and Lo, Wen-Juo
and Massey, M. Philip",
title="Developing an Online Community Advisory Board (CAB) of Parents From Social Media to Co-Design an Human Papillomavirus Vaccine Intervention: Participatory Research Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="16",
volume="9",
pages="e65986",
keywords="online community advisory boards",
keywords="community engagement",
keywords="social media",
keywords="digital health",
keywords="digital health intervention",
keywords="HPV vaccine",
keywords="human papillomavirus",
keywords="HPV",
keywords="parent health",
keywords="child health",
abstract="Background: Social media health interventions have grown significantly in recent years. However, researchers are still developing innovative methods to meaningfully engage online communities to inform research activities. Little has been documented describing this approach of using online community advisory boards (CABs) to co-create health communication interventions on social media. Objective: This study describes the formation, engagement, and maintenance of an online CAB focused on co-creating a health education intervention for parents regarding the human papillomavirus (HPV) vaccine. The study provides guiding principles for public health researchers implementing such CABs in future digital health interventions. Methods: In May 2020, Twitter was used to recruit parents of children aged 9?14 years, who were active users of the platform and were interested in serving on a CAB focused on child health and online programs. The recruitment campaign included Twitter (rebranded as X in 2023) advertising tools (eg, ``interests'' and ``audience look-a-likes''). A total of 17 parents completed a screening survey and 6 completed a follow-up phone interview. Following phone interviews, 6 parents were invited to join the CAB, where they committed to a 1-year involvement. The CAB participated in eleven 1-hour online meetings in the first year, contributing to monthly feedback through participatory workbooks. Long-term engagement was sustained through icebreakers and casual online interactions, as well as providing real-time updates to demonstrate CAB feedback integration. An anonymous midterm evaluation was conducted at the end of the project's first year to assess processes and identify future growth opportunities. Results: A total of 6 parents (5 females and 1 male) with children aged 9-14 years from diverse racial and ethnic backgrounds (African American, South Asian American, and White) across 6 states in the United States, representing urban, suburban, and rural areas, agreed to serve as CAB members. All 6 CAB members committed to 1 year of service beginning in July 2020 with 4 extending their participation into a second year (August 2021-August 2022). The CAB provided expert insights and feedback to co-develop the intervention, including character development, narrative content creation, study recruitment, survey development, and intervention delivery. The midterm evaluation showed 100\% (6/6) satisfaction among CAB members, who valued the connections with other parents and their contribution to research. While all members felt confident discussing HPV, 83\% (5/6) suggested diversifying the group and increasing informal bonding to enhance engagement and inclusivity, especially for differing vaccination views. Conclusions: This study demonstrates that online CABs are a highly effective model for co-creating and informing online health communication interventions. The engagement of parents from diverse backgrounds and the structured use of online tools (eg, interactive workbooks) creates a constructive and thoughtful environment for incorporating parent contributions to research. This study highlights guiding principles to forming, engaging, and maintaining an online CAB to enhance health research and practice. ",
doi="10.2196/65986",
url="https://formative.jmir.org/2025/1/e65986"
}


@Article{info:doi/10.2196/71865,
author="Kim, Minjin
and Kim, Ellie
and Lee, Hyeongsuk
and Piao, Meihua
and Rosen, Brittany
and Allison, J. Jeroan
and Zai, H. Adrian
and Nguyen, L. Hoa
and Shin, Dong-Soo
and Kahn, A. Jessica",
title="A Culturally Tailored Artificial Intelligence Chatbot (K-Bot) to Promote Human Papillomavirus Vaccination Among Korean Americans: Development and Usability Study",
journal="Asian Pac Isl Nurs J",
year="2025",
month="Apr",
day="7",
volume="9",
pages="e71865",
keywords="human papillomavirus",
keywords="HPV vaccination",
keywords="artificial intelligence",
keywords="AI",
keywords="chatbot intervention",
keywords="Korean Americans",
keywords="usability testing",
keywords="culturally tailored intervention",
abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide and is associated with various cancers, including cervical and oropharyngeal cancers. Despite the availability of effective vaccines, significant disparities in HPV vaccination rates persist, particularly among racial and ethnic minorities, such as Korean Americans. Cultural stigma, language barriers, and limited access to tailored health information contribute to these disparities. Objective: This study aimed to develop and evaluate the usability of K-Bot, an artificial intelligence (AI)--powered, culturally tailored, bilingual (Korean and English) chatbot designed to provide culturally sensitive health information about HPV vaccination to Korean immigrants and Korean Americans. Methods: K-Bot was developed using CloudTuring and Google Dialogflow. Its dialogues were created using Centers for Disease Control and Prevention (CDC) evidence-based HPV information and tailored to the Korean American population based on findings from previous studies. The evaluation and refinement process for K-Bot was organized into 3 phases: (1) expert evaluation by a multidisciplinary panel, (2) usability testing, and (3) iterative refinement based on feedback. An online survey collected demographics, HPV awareness, and vaccination status before 6 focus groups (N=21) sessions using semistructured questions guided by Peter Morville's usability framework. Quantitative data were analyzed descriptively, and thematic analysis assessed usability, cultural relevance, and content clarity across 6 dimensions: desirability, accessibility, findability, credibility, usability, and usefulness. Results: Participants had a mean age of 23.7 (SD 4.7) years, with most being female (n=12, 57.1\%), second-generation individuals (n=13, 61.9\%), and single (n=20, 95.2\%). HPV awareness was high (n=19, 90.5\%), vaccine knowledge was also high (n=18, 81.8\%), but only 11 (52.4\%) participants were vaccinated. Feedback-driven refinements addressed usability challenges, including simplifying navigation and adding visual elements. Participants described K-Bot as a promising tool for promoting HPV vaccination among Korean and Korean American users, citing its bilingual functionality and culturally tailored content as key strengths. Evidence-based information was valued, but participants recommended visuals to improve engagement and reduce cognitive load. Accessibility concerns included broken links, and participants proposed enhancements, such as animations, demographic-specific resources, and interactive features, to improve usability and engagement further. Conclusions: Usability testing of K-Bot revealed its potential as a culturally tailored, bilingual tool for promoting HPV vaccination among Korean immigrants and Korean Americans. Participants valued its evidence-based information, cultural relevance, and bilingual functionality but recommended improvements, such as enhanced navigation, visual elements, and interactive features, to boost engagement and usability. These findings support the potential of AI-driven tools to improve health care access by addressing key barriers to care. Further research is needed to evaluate their broader impact and optimize their design and implementation for individuals with diverse health care needs. ",
doi="10.2196/71865",
url="https://apinj.jmir.org/2025/1/e71865"
}


@Article{info:doi/10.2196/69609,
author="Adegboyega, Adebola
and Wiggins, Amanda
and Wuni, Abubakari
and Ickes, Melinda",
title="The Impact of a Human Papillomavirus Facebook-Based Intervention (\#HPVVaxTalks) Among Young Black (African American and Sub-Saharan African Immigrants) Adults: Pilot Pre- and Poststudy",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="2",
volume="9",
pages="e69609",
keywords="human papillomavirus vaccination",
keywords="HPV vaccination",
keywords="Facebook-based intervention",
keywords="young Black adults",
keywords="social media",
abstract="Background: Despite the availability of prophylactic human papillomavirus (HPV) vaccines, uptake remains suboptimal among young Black adults. Social media is a platform for the dissemination of health information and can be used to promote HPV vaccination among young Black adults. Objective: This study aimed to assess the impact of a Facebook-based intervention (\#HPVVaxTalks), which consisted of 40 posts over 8 weeks in improving cognitive outcomes, reducing vaccine hesitancy, and increasing vaccine intention, and uptake among young Black adults aged 18-26 years. Methods: A pilot 1-group pre- and poststudy was conducted among 43 young Black adults who engaged in an 8-week Facebook intervention (\#HPVVaxTalks). \#HPVVaxTalks was developed in collaboration with a youth community advisory committee. Participants were actively recruited by research staff from community settings using flyers, and flyers were posted in public places in communities. Eligible participants were screened for eligibility and consented prior to study participation. Participants completed baseline surveys and were added to a Facebook page created for the study to receive intervention posts. Participants completed pre- and postdata on HPV knowledge, HPV vaccine knowledge, vaccine hesitancy, and vaccine uptake via REDCap (Research Electronic Data Capture) surveys distributed by email. Participants' satisfaction with the intervention was collected via individual interviews. Data were analyzed using 2-tailed paired t tests and repeated measures analysis Results: Overall, 32 of the 43 (74\%) participants completed the follow-up survey, and of the 23 participants who reported not having ever received the vaccine at baseline, 7 (30\%) reported receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge and receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge (pre: mean 7.3, SD 4.2 and post: mean 11.1, SD 4.3; P=.004) and HPV vaccine knowledge (pre: mean 2.8, SD 2.5 and post: mean 4.7, SD 2.2; P=.003) and reduction in vaccine hesitancy (pre: mean 28.3, SD 4.2 and post: mean 29.9, SD 3.6; P=.007) after the intervention. However, there were no significant changes in other outcomes. Feedback from open-ended questions and qualitative interviews highlighted participants' satisfaction with the intervention and its role in increasing HPV and HPV vaccine awareness. Conclusions: The findings from this study underscore the potential of social media platforms for health promotion among underrepresented populations and the importance of advocating for culturally appropriate interventions to improve HPV vaccination rates and reduce disparities. ",
doi="10.2196/69609",
url="https://formative.jmir.org/2025/1/e69609"
}


@Article{info:doi/10.2196/65542,
author="Nasrudin, Nurfarhana
and Sazlina, Shariff-Ghazali
and Cheong, Theng Ai
and Lee, Yein Ping
and Teo, Soo-Hwang
and Aneesa, Rashid Abdul
and Teo, Hai Chin
and Rokhani, Zaman Fakhrul
and Haron, Azam Nuzul
and Harrun, Harzana Noor
and Ho, Kiau Bee
and Mohamed Isa, Salbiah",
title="Increasing the Uptake of Breast and Cervical Cancer Screening Via the MAwar Application: Stakeholder-Driven Web Application Development Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="28",
volume="9",
pages="e65542",
keywords="cancer screening",
keywords="stakeholder engagement",
keywords="Quality Function Deployment",
keywords="web health app",
abstract="Background: Digital health interventions such as web health applications significantly enhance screening accessibility and uptake, particularly for individuals with low literacy and income levels. By involving stakeholders---including health care professionals, patients, and technical experts---an intervention can be tailored to effectively meet the users' needs, ensuring contextual relevance for better acceptance and impact. Objective: The aim of this study is to prioritize the content and user interface appropriate for developing a web health application, known as the MAwar app, to promote breast and cervical cancer screening. Methods: A cross-sectional study for stakeholder engagement was conducted to develop a web-based application known as the MAwar app as part of a larger study entitled ``The Effectiveness of an Interactive Web Application to Motivate and Raise Awareness on Early Detection of Breast and Cervical Cancers (The MAwar study)''. The stakeholder engagement process was conducted in a public health district that oversees 12 public primary care clinics with existing cervical and breast cancer screening programs. We purposively selected the stakeholders for their relevant roles in breast and cervical cancer screening (health care staff, patients, and public representatives), as well as expertise in software and user interface design (technology experts). The Quality Function Deployment method was used to reflect the priorities of diverse stakeholders (health care, technology experts, patients, and public representatives) in its design. The Quality Function Deployment method facilitated the translation of stakeholder perspectives into app features. Stakeholders rated features on a scale from 1 (least important) to 5 (most important), ensuring the app's design resonated with user needs. The correlations between the ``WHATs'' (user requirements) and the ``HOWs'' (technical requirements) were scored using a 3-point ordinal scale, with 1 indicating weak correlation, 5 indicating medium correlation, and 9 indicating the strongest correlation. Results: A total of 13 stakeholders participated in the study, including women who had either underwent or never had health screening, a health administrator, a primary care physician, medical officers, nurses, and software designers. Stakeholder evaluations highlighted cost-free access (mean 4.64, SD 0.81), comprehensive cancer information (mean 4.55, SD 0.69), detailed screening benefits (mean 4.45, SD 0.68), detailed screening facilities (mean 4.45, SD 0.68) and personalized risk calculator for breast and cervical cancers (mean 4.45, SD 0.68) as essential priorities of the app. The highest-ranked features include detailed information on screening procedures (weighted score [WS]=367.84), information on treatment options (WS=345.80), benefits of screening (WS=333.75), information about breast and cervical cancers (WS=332.15), and frequently asked questions about the concerns around screening (WS=312.00). Conclusions: The MAwar app, conceived through a collaborative, stakeholder-driven process, represents a significant step in leveraging digital health solutions to tackle cancer screening disparities. By prioritizing accessibility, information quality, and clarity on benefits, the app promises to encourage early cancer detection and management for targeted communities. Trial Registration: ISRCTN Registry ISRCTN10403163; https://www.isrctn.com/ISRCTN10403163 ",
doi="10.2196/65542",
url="https://formative.jmir.org/2025/1/e65542"
}


@Article{info:doi/10.2196/68881,
author="Liu, Junyu
and Niu, Qian
and Nagai-Tanima, Momoko
and Aoyama, Tomoki",
title="Understanding Human Papillomavirus Vaccination Hesitancy in Japan Using Social Media: Content Analysis",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="11",
volume="27",
pages="e68881",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="vaccine confidence",
keywords="large language model",
keywords="stance analysis",
keywords="topic modeling",
abstract="Background: Despite the reinstatement of proactive human papillomavirus (HPV) vaccine recommendations in 2022, Japan continues to face persistently low HPV vaccination rates, which pose significant public health challenges. Misinformation, complacency, and accessibility issues have been identified as key factors undermining vaccine uptake. Objective: This study aims to examine the evolution of public attitudes toward HPV vaccination in Japan by analyzing social media content. Specifically, we investigate the role of misinformation, public health events, and cross-vaccine attitudes (eg, COVID-19 vaccines) in shaping vaccine hesitancy over time. Methods: We collected tweets related to the HPV vaccine from 2011 to 2021. Natural language processing techniques and large language models (LLMs) were used for stance analysis of the collected data. Time series analysis and latent Dirichlet allocation topic modeling were used to identify shifts in public sentiment and topic trends over the decade. Misinformation within opposed-stance tweets was detected using LLMs. Furthermore, we analyzed the relationship between attitudes toward HPV and COVID-19 vaccines through logic analysis. Results: Among the tested models, Gemini 1.0 pro (Google) achieved the highest accuracy (0.902) for stance analysis, improving to 0.968 with hyperparameter tuning. Time series analysis identified significant shifts in public stance in 2013, 2016, and 2020, corresponding to key public health events and policy changes. Topic modeling revealed that discussions around vaccine safety peaked in 2015 before declining, while topics concerning vaccine effectiveness exhibited an opposite trend. Misinformation in topic ``Scientific Warnings and Public Health Risk'' in the sopposed-stance tweets reached a peak of 2.84\% (47/1656) in 2012 and stabilized at approximately 0.5\% from 2014 onward. The volume of tweets using HPV vaccine experiences to argue stances on COVID-19 vaccines was significantly higher than the reverse. Conclusions: Based on observation on the public attitudes toward HPV vaccination from social media contents over 10 years, our findings highlight the need for targeted public health interventions to address vaccine hesitancy in Japan. Although vaccine confidence has increased slowly, sustained efforts are necessary to ensure long-term improvements. Addressing misinformation, reducing complacency, and enhancing vaccine accessibility are key strategies for improving vaccine uptake. Some evidence suggests that confidence in one vaccine may positively influence perceptions of other vaccines. This study also demonstrated the use of LLMs in providing a comprehensive understanding of public health attitudes. Future public health strategies can benefit from these insights by designing effective interventions to boost vaccine confidence and uptake. ",
doi="10.2196/68881",
url="https://www.jmir.org/2025/1/e68881"
}


@Article{info:doi/10.2196/64668,
author="Marshall, J. Daniel
and Gower, L. Amy
and Katz, L. Mira
and Bauermeister, A. Jos{\'e}
and Shoben, B. Abigail
and Reiter, L. Paul",
title="Recruitment of Young Gay, Bisexual, and Other Men Who Have Sex With Men for a Web-Based Human Papillomavirus Vaccination Intervention: Differences in Participant Characteristics and Study Engagement by Recruitment Source in a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="3",
volume="27",
pages="e64668",
keywords="study recruitment",
keywords="gay and bisexual men",
keywords="human papillomavirus",
keywords="vaccination promotion",
keywords="digital intervention",
keywords="social media",
keywords="dating apps",
keywords="recruitment",
keywords="young adults",
keywords="adolescents",
keywords="gay",
keywords="bisexual",
keywords="men who have sex with men",
abstract="Background: Young gay, bisexual, and other men who have sex with men have been referred to as a ``hard-to-reach'' or ``hidden'' community in terms of recruiting for research studies. With widespread internet use among this group and young adults in general, web-based avenues represent an important approach for reaching and recruiting members of this community. However, little is known about how participants recruited from various web-based sources may differ from one another. Objective: This study aimed to determine how young gay, bisexual, and other men who have sex with men recruited from various web-based sources differ from one another in terms of participant characteristics and study engagement. Methods: Data were collected as part of a randomized controlled trial of Outsmart HPV, a web-based human papillomavirus?(HPV) vaccination intervention for young gay, bisexual, and other men who have sex with men. From 2019 to 2021, we recruited young gay, bisexual, and other men who have sex with men in the United States who were aged 18-25 years and not vaccinated against HPV (n=1227) through various web-based avenues. We classified each participant as being recruited from either (1) social media (eg, Facebook, Instagram, Snapchat), (2) a dating app (eg, Grindr, Scruff), or (3) some other digital recruitment source (eg, existing research panel, university-based organization). Analyses compared participants from these 3 groups on demographic and health-related characteristics and metrics involving study engagement. Results: Most demographic and health-related characteristics differed by web-based recruitment source, including race or ethnicity (P<.001), relationship status (P<.001), education level (P<.001), employment status (P<.001), sexual self-identity (P<.001), health insurance status (P<.001), disclosure of sexual orientation (P=.048), and connectedness to the LGBTQ (lesbian, gay, bisexual, transgender, queer) community (P<.001) The type of device used by participants during study enrollment also differed across groups, with smartphone use higher among participants recruited via dating apps (n=660, 96.6\%) compared to those recruited via social media (n=318, 78.9\%) or other digital sources (n=85, 60.3\%; P<.001). Participants recruited via social media were more likely than those recruited via dating apps to complete follow-up surveys at 3 different timepoints (odds ratios 1.52-2.09, P=.001-.008). These participants also spent a longer amount of time viewing intervention content about HPV vaccination (3.14 minutes vs 2.67 minutes; P=.02). Conclusions: We were able to recruit a large national sample of young gay, bisexual, and other men who have sex with men for a web-based HPV vaccination intervention via multiple methodologies. Participants differed on a range of demographic and health-related characteristics, as well as metrics related to study engagement, based on whether they were recruited from social media, a dating app, or some other digital recruitment source. Findings highlight key issues and considerations that can help researchers better plan and customize future web-based recruitment efforts of young gay, bisexual, and other men who have sex with men. Trial Registration: ClinicalTrials.gov NCT04032106; https://clinicaltrials.gov/study/NCT04032106 International Registered Report Identifier (IRRID): RR2-10.2196/16294 ",
doi="10.2196/64668",
url="https://www.jmir.org/2025/1/e64668"
}


@Article{info:doi/10.2196/52738,
author="Gong, Jie
and Gu, Dandan
and Dong, Suyun
and Shen, Wangqin
and Yan, Haiou
and Xie, Juan",
title="Effects of Message Framing on Human Papillomavirus Vaccination: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="7",
volume="26",
pages="e52738",
keywords="message framing",
keywords="gain-loss framing",
keywords="human?papillomavirus",
keywords="vaccination",
keywords="attitude",
keywords="intention",
keywords="behavior",
keywords="systematic review",
keywords="PRISMA",
abstract="Background: With the advancement of cervical cancer elimination strategies, promoting human papillomavirus (HPV) vaccination is essential to achieving this goal. The issue of how to structure and develop message content to promote HPV vaccination is a debatable issue. Objective: The efficacy of gain-loss framing in vaccination contexts is disputed. Our study aimed to elucidate the consequences of message framing on attitudes, intentions, and behavioral tendencies toward HPV vaccination, with the objective of refining message framing strategies and their elements. Methods: This systematic review adhered strictly to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guideline reporting standards to comprehensively retrieve, extract, and integrate data. We searched databases, including PubMed, Embase, Scopus, and Web of Science, for literature published from database construction to August 15, 2023. Literature screening, data extraction, and quality evaluation were performed by 2 researchers. Intervention studies published in English, conducted with populations with children eligible for HPV vaccination, and involving message framing were included. Attitudes, intentions, and behaviors served as outcome evaluation criteria. Results: A total of 19 intervention studies were included. Gain-loss framing had no clear effect on vaccination attitudes nor intentions. Loss framing showed a weak advantage at improving HPV vaccination attitudes or intentions, but the evidence was not strong enough to draw definitive conclusions. The impact of gain-loss framing on HPV vaccination behaviors could not be determined due to the limited number of studies and the qualitative nature of the analysis. Conclusions: Combining gain-loss framing with other message framing approaches may be an effective way to enhance the effect of message framing. More high-quality message framing content and exploring alternative moderator or mediator variables are required to support the conclusion. Trial Registration: CRD42023451612; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=451612 ",
doi="10.2196/52738",
url="https://www.jmir.org/2024/1/e52738"
}


@Article{info:doi/10.2196/59087,
author="Kim, Youlim
and Lee, Hyeonkyeong
and Park, Jeongok
and Kim, Yong-Chan
and Kim, Hee Dong
and Lee, Young-Me",
title="eHealth Communication Intervention to Promote Human Papillomavirus Vaccination Among Middle-School Girls: Development and Usability Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="28",
volume="8",
pages="e59087",
keywords="cervical cancer",
keywords="human papillomavirus",
keywords="vaccines",
keywords="health communication",
keywords="chatbot",
keywords="artificial intelligence",
keywords="adolescent",
keywords="mobile phone",
abstract="Background: As the age of initiating sexual intercourse has gradually decreased among South Korean adolescents, earlier vaccination of adolescents for human papillomavirus (HPV) is necessary before their exposure to HPV. Health communication includes ``cues to action'' that lead to preventive health behaviors, and recently, social networking services, which operate with fewer time and space constraints, have been used in various studies as a form of eHealth communication. Objective: This study aims to investigate the feasibility and usability of an eHealth communication intervention for HPV vaccination in middle-school girls aimed at the girls and their mothers. Methods: The eHealth communication intervention for HPV vaccination was developed using a 6-step intervention mapping process: needs assessments, setting program outcomes, selection of a theory-based method and practical strategies, development of the intervention, implementation plan, and testing the validity of the intervention. Results: A review of 10 studies identified effective health communication messages, delivery methods, and theories for HPV vaccination among adolescents. Barriers including low knowledge, perceived threat, and the inconvenience of taking 2 doses of the vaccine were identified through focus groups, suggesting a need for youth-friendly and easy-to-understand information for adolescents delivered via mobile phones. The expected outcomes and the performance objectives are specifically tailored to reflect the vaccination intention. Behavior change techniques were applied using trusted sources and a health belief model. Health messages delivered through a KakaoTalk chatbot improved awareness and self-efficacy. Quality control was ensured with the use of a log system. The experts' chatbot usability average score was 80.13 (SD 8.15) and the average score of girls was 84.06 (SD 7.61). Conclusions: Future studies need to verify the effectiveness of health communication strategies in promoting HPV vaccination and the effectiveness of scientific intervention using a chatbot as a delivery method for the intervention. ",
doi="10.2196/59087",
url="https://formative.jmir.org/2024/1/e59087",
url="http://www.ncbi.nlm.nih.gov/pubmed/39466304"
}


@Article{info:doi/10.2196/52926,
author="Fallucca, Alessandra
and Priano, Walter
and Carubia, Alessandro
and Ferro, Patrizia
and Pisciotta, Vincenzo
and Casuccio, Alessandra
and Restivo, Vincenzo",
title="Effectiveness of Catch-Up Vaccination Interventions Versus Standard or Usual Care Procedures in Increasing Adherence to Recommended Vaccinations Among Different Age Groups: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Before-After Studies",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="23",
volume="10",
pages="e52926",
keywords="vaccine strategies",
keywords="catch-up interventions",
keywords="recall intervention",
keywords="vaccination coverage",
keywords="multicomponent",
keywords="education",
keywords="remind",
keywords="reward",
keywords="vaccination",
keywords="vaccine",
keywords="adherence",
keywords="systematic review",
keywords="meta-analysis",
keywords="immunization",
keywords="health care based",
keywords="multidimensional intervention",
keywords="education based",
keywords="vaccine literacy",
keywords="PRISMA",
abstract="Background: To address the global challenge of vaccine hesitancy, the Strategic Advisory Group of Experts on Immunization strongly promotes vaccination reminder and recall interventions. Coupled with the new opportunities presented by scientific advancements, these measures are crucial for successfully immunizing target population groups. Objective: This systematic review and meta-analysis aims to assess the effectiveness of various interventions in increasing vaccination coverage compared with standard or usual care. The review will cover all vaccinations recommended for different age groups. Methods: In February 2022, 2 databases were consulted, retrieving 1850 studies. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 79 manuscripts were included after the assessment phase. These comprised 46 trials/randomized controlled trials (RCTs) and 33 before-after studies. A meta-analysis using a random-effects model was performed with STATA software (version 14.1.2). The selected outcome was the risk ratio (RR) of vaccination coverage improvement effectiveness. Additionally, meta-regression analyses were conducted for the included manuscripts. Results: The analyses showed an overall efficacy of RR 1.22 (95\% CI 1.19-1.26) for RCTs and RR 1.70 (95\% CI 1.54-1.87) for before-after studies when considering all interventions cumulatively. Subgroup analyses identified multicomponent interventions (RR 1.58, 95\% CI 1.36-1.85) and recall clinical interventions (RR 1.24, 95\% CI 1.17-1.32) as the most effective in increasing vaccination coverage for RCTs. By contrast, educational interventions (RR 2.13, 95\% CI 1.60-2.83) and multicomponent interventions (RR 1.61, 95\% CI 1.43-1.82) achieved the highest increases for before-after studies. Meta-regression analyses indicated that the middle-aged adult population was associated with a higher increase in vaccination coverage (RCT: coefficient 0.54, 95\% CI 0.12-0.95; before-after: coefficient 1.27, 95\% CI 0.70-1.84). Conclusions: Community, family, and health care--based multidimensional interventions, as well as education-based catch-up strategies, effectively improve vaccination coverage. Therefore, their systematic implementation is highly relevant for targeting undervaccinated population groups. This approach aligns with national vaccination schedules and aims to eliminate or eradicate vaccine-preventable diseases. ",
doi="10.2196/52926",
url="https://publichealth.jmir.org/2024/1/e52926"
}


@Article{info:doi/10.2196/57118,
author="Dionne, Maude
and Sauvageau, Chantal
and Etienne, Doriane
and Kiely, Marilou
and Witteman, Holly
and Dub{\'e}, Eve",
title="Development of Promising Interventions to Improve Human Papillomavirus Vaccination in a School-Based Program in Quebec, Canada: Results From a Formative Evaluation Using a Mixed Methods Design",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="8",
volume="8",
pages="e57118",
keywords="immunization",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="school-based immunization program",
keywords="intervention",
keywords="strategies",
keywords="vaccination",
keywords="vaccine",
keywords="Quebec",
keywords="school-based",
keywords="vaccine coverage",
keywords="decision aid",
keywords="student",
keywords="students",
keywords="nurse",
keywords="nurses",
keywords="parent",
keywords="parents",
keywords="focus group",
keywords="descriptive analyses",
keywords="user-centered",
keywords="effectiveness",
keywords="data collection",
keywords="vaccine safety",
abstract="Background: Despite the availability of school-based human papillomavirus (HPV) vaccination programs, disparities in vaccine coverage persist. Barriers to HPV vaccine acceptance and uptake include parental attitudes, knowledge, beliefs, and system-level barriers. A total of 3 interventions were developed to address these barriers: an in-person presentation by school nurses, an email reminder with a web-based information and decision aid tool, and a telephone reminder using motivational interviewing (MI) techniques. Objective: Here we report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among grade 4 students' parents in Quebec, Canada. Methods: In the summer of 2019, we conducted a formative evaluation of the interventions to assess the interventions' relevance, content, and format and to identify any unmet needs. We conducted 3 focus group discussions with parents of grade 3 students and nurses. Interviews were recorded, transcribed, and analyzed for thematic content using NVivo software (Lumivero). Nurses received training on MI techniques and we evaluated the effect on nurses' knowledge and skills using a pre-post questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to the training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centered design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool's relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU (Centre Hospitalier Universitaire) de Qu{\'e}bec Research Ethics Committee (MP-20-2019-4655, May 16, 2019). Results: The data collection was conducted from April 2019 to March 2021. Following feedback (n=28) from the 3 focus group discussions in June 2019, several changes were made to the in-person presentation intervention. Experts (n=27) and school nurses (n=29) recruited for the project appreciated the visual and simplified information on vaccination in it. The results of the MI training for school nurses conducted in August 2019 demonstrated an increase in the skills and knowledge of nurses (n=29). School nurses who took the web-based course (n=24) filled out a pretest and posttest questionnaire to evaluate their learning. The rating increased by 19\% between the pretest and posttest questionnaires. Several changes were made between the first draft of the web-based decision-aid tool and the final version during the summer of 2019 after an expert consultation of experts (n=3), focus group participants (n=28), and parents in the iterative process (n=5). More information about HPV and vaccines was added, and users could click if more detail is desired. Conclusions: We developed and pilot-tested 3 interventions using an iterative process. The interventions were perceived as potentially effective to increase parents' knowledge and positive attitudes toward HPV vaccination, and ultimately, vaccine acceptance. Future research will assess the effectiveness of these interventions on a larger scale. ",
doi="10.2196/57118",
url="https://formative.jmir.org/2024/1/e57118",
url="http://www.ncbi.nlm.nih.gov/pubmed/38976317"
}


@Article{info:doi/10.2196/50551,
author="Jessiman-Perreault, Genevi{\`e}ve
and Boucher, Jean-Christophe
and Kim, Youn So
and Frenette, Nicole
and Badami, Abbas
and Smith, M. Henry
and Allen Scott, K. Lisa",
title="The Role of Scientific Research in Human Papillomavirus Vaccine Discussions on Twitter: Social Network Analysis",
journal="JMIR Infodemiology",
year="2024",
month="May",
day="9",
volume="4",
pages="e50551",
keywords="human papillomavirus",
keywords="HPV",
keywords="vaccine",
keywords="immunization",
keywords="social media",
keywords="misinformation",
keywords="social network analysis",
abstract="Background: Attitudes toward the human papillomavirus (HPV) vaccine and accuracy of information shared about this topic in web-based settings vary widely. As real-time, global exposure to web-based discourse about HPV immunization shapes the attitudes of people toward vaccination, the spread of misinformation and misrepresentation of scientific knowledge contribute to vaccine hesitancy. Objective: In this study, we aimed to better understand the type and quality of scientific research shared on Twitter (recently rebranded as X) by vaccine-hesitant and vaccine-confident communities. Methods: To analyze the use of scientific research on social media, we collected tweets and retweets using a list of keywords associated with HPV and HPV vaccines using the Academic Research Product Track application programming interface from January 2019 to May 2021. From this data set, we identified tweets referring to or sharing scientific literature through a Boolean search for any tweets with embedded links, hashtags, or keywords associated with scientific papers. First, we used social network analysis to build a retweet or reply network to identify the clusters of users belonging to either the vaccine-confident or vaccine-hesitant communities. Second, we thematically assessed all shared papers based on typology of evidence. Finally, we compared the quality of research evidence and bibliometrics between the shared papers in the vaccine-confident and vaccine-hesitant communities. Results: We extracted 250 unique scientific papers (including peer-reviewed papers, preprints, and gray literature) from approximately 1 million English-language tweets. Social network maps were generated for the vaccine-confident and vaccine-hesitant communities sharing scientific research on Twitter. Vaccine-hesitant communities share fewer scientific papers; yet, these are more broadly disseminated despite being published in less prestigious journals compared to those shared by the vaccine-confident community. Conclusions: Vaccine-hesitant communities have adopted communication tools traditionally wielded by health promotion communities. Vaccine-confident communities would benefit from a more cohesive communication strategy to communicate their messages more widely and effectively. ",
doi="10.2196/50551",
url="https://infodemiology.jmir.org/2024/1/e50551",
url="http://www.ncbi.nlm.nih.gov/pubmed/38722678"
}


@Article{info:doi/10.2196/45508,
author="Malkin, Jennifer
and Jessiman-Perreault, Genevi{\`e}ve
and Alberga Machado, Amanda
and Teare, Gary
and Snider, Joanne
and Tirmizi, Farhan Syed
and Youngson, Erik
and Wang, Ting
and Law, Jessica
and Bandara, Thilina
and Rathwell, Mika
and Neudorf, Cordell
and Allen Scott, Lisa",
title="Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="27",
volume="10",
pages="e45508",
keywords="co-design",
keywords="geospatial",
keywords="human papillomavirus",
keywords="immunization",
keywords="population-based",
keywords="vaccine",
abstract="Background: Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. Objective: The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. Methods: Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. Results: The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95\% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95\% CI 1.006-1.185) and 1.831 (95\% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95\% CI 1.200-1.381) and 1.099 (95\% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95\% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. Conclusions: Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions. ",
doi="10.2196/45508",
url="https://publichealth.jmir.org/2024/1/e45508",
url="http://www.ncbi.nlm.nih.gov/pubmed/38536211"
}


@Article{info:doi/10.2196/54000,
author="Boatman, Dannell
and Starkey, Abby
and Acciavatti, Lori
and Jarrett, Zachary
and Allen, Amy
and Kennedy-Rea, Stephenie",
title="Using Social Listening for Digital Public Health Surveillance of Human Papillomavirus Vaccine Misinformation Online: Exploratory Study",
journal="JMIR Infodemiology",
year="2024",
month="Mar",
day="8",
volume="4",
pages="e54000",
keywords="human papillomavirus",
keywords="HPV",
keywords="vaccine",
keywords="vaccines",
keywords="vaccination",
keywords="vaccinations",
keywords="sexually transmitted infection",
keywords="STI",
keywords="sexually transmitted disease",
keywords="STD",
keywords="sexual transmission",
keywords="sexually transmitted",
keywords="social media",
keywords="social listening",
keywords="cancer",
keywords="surveillance",
keywords="health communication",
keywords="misinformation",
keywords="artificial intelligence",
keywords="AI",
keywords="infodemiology",
keywords="infoveillance",
keywords="oncology",
doi="10.2196/54000",
url="https://infodemiology.jmir.org/2024/1/e54000",
url="http://www.ncbi.nlm.nih.gov/pubmed/38457224"
}


@Article{info:doi/10.2196/50210,
author="Ammar, Nariman
and Olusanya, A. Olufunto
and Melton, Chad
and Chinthala, Lokesh
and Huang, Xiaolei
and White, M. Brianna
and Shaban-Nejad, Arash",
title="Digital Personal Health Coaching Platform for Promoting Human Papillomavirus Infection Vaccinations and Cancer Prevention: Knowledge Graph-Based Recommendation System",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="15",
volume="7",
pages="e50210",
keywords="health information exchanges",
keywords="knowledge graphs",
keywords="recommender systems",
keywords="personal health libraries",
keywords="vaccine promotion",
keywords="cancer prevention",
keywords="personal health informatics",
abstract="Background: Health promotion can empower populations to gain more control over their well-being by using digital interventions that focus on preventing the root causes of diseases. Digital platforms for personalized health coaching can improve health literacy and information-seeking behavior, leading to better health outcomes. Personal health records have been designed to enhance patients' self-management of a disease or condition. Existing personal health records have been mostly designed and deployed as a supplementary service that acts as views into electronic health records. Objective: We aim to overcome some of the limitations of electronic health records. This study aims to design and develop a personal health library (PHL) that generates personalized recommendations for human papillomavirus (HPV) vaccine promotion and cancer prevention. Methods: We have designed a proof-of-concept prototype of the Digital Personal Health Librarian, which leverages machine learning; natural language processing; and several innovative technological infrastructures, including the Semantic Web, social linked data, web application programming interfaces, and hypermedia-based discovery, to generate a personal health knowledge graph. Results: We have designed and implemented a proof-of-the-concept prototype to showcase and demonstrate how the PHL can be used to store an individual's health data, for example, a personal health knowledge graph. This is integrated with web-scale knowledge to support HPV vaccine promotion and prevent HPV-associated cancers among adolescents and their caregivers. We also demonstrated how the Digital Personal Health Librarian uses the PHL to provide evidence-based insights and knowledge-driven explanations that are personalized and inform health decision-making. Conclusions: Digital platforms such as the PHL can be instrumental in improving precision health promotion and education strategies that address population-specific needs (ie, health literacy, digital competency, and language barriers) and empower individuals by facilitating knowledge acquisition to make healthy choices. ",
doi="10.2196/50210",
url="https://formative.jmir.org/2023/1/e50210",
url="http://www.ncbi.nlm.nih.gov/pubmed/37966885"
}


@Article{info:doi/10.2196/47379,
author="Gandelin, Maxence
and Tran, Lien Phuong
and Chirpaz, Emmanuel
and Jaffar-Bandjee, Marie-Christine
and Traversier, Nicolas
and Machalek, Dorothy
and Bertolotti, Antoine",
title="Human Papillomavirus (HPV) Infections Among Participants Undergoing Chlamydia trachomatis Testing in Reunion Island (RUN-SurV-HPV Study): Protocol for a Prevalence Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="31",
volume="12",
pages="e47379",
keywords="human papillomavirus",
keywords="HPV",
keywords="Reunion Island",
keywords="epidemiological study",
keywords="vaccination",
keywords="vaccine",
keywords="sexual health",
keywords="sexual transmission",
keywords="sexually transmitted infection",
keywords="STI",
keywords="epidemiological",
keywords="epidemiology",
keywords="cross-sectional",
keywords="genotyping",
abstract="Background: Infection by human papillomavirus (HPV) induces various cancers, mainly cervical cancer but also anal and pharyngeal cancers. Reunion Island is a French department in the Indian Ocean. Due to the history of its settlement, the island's population has a wide variety of origins, and the population's sociodemographic characteristics differ from those of the French mainland. These characteristics make the island's population an original French population in its own right, particularly in terms of health. Cervical cancer incidence and mortality in Reunion Island are 10.4 per 100,000 and 4.4 per 100,000, respectively, both of which are much higher than those in mainland France. There is also a disparity in the prevalence of different HPV types, with types 33 and 52 being overrepresented and type 18 being underrepresented. However, vaccination and screening coverage in Reunion Island is low. It is important to understand the burden of infection and its risk factors in members of the young Reunionese population at risk of HPV infection to promote and evaluate the implementation of future vaccination and screening programs on a larger scale. Objective: The RUN-SurV-HPV study will have the following four objectives: (1) to describe the prevalence of HPV genotypes in a population at risk of sexually transmitted infections in Reunion Island; (2) to describe the prevalence of HPV genotypes by anatomical site, gender, and sexuality; (3) to describe the correlates and risk factors for HPV detection; and (4) to examine HPV genotypes between different anatomical sites. Methods: Cross-sectional analyses of 1200 routine vaginal, anal, pharyngeal, and urinary samples collected between October 2020 to December 2022 from female and male patients aged 16 to 30 years undergoing Chlamydia trachomatis testing at a sexually transmitted infection (STI) testing center at Reunion Island will be performed. The population included 333 women who all had vaginal and pharyngeal swabs, with 80 of them also having had an anal swab. There are 167 men who have sex with men who have had anal and pharyngeal swabs, and 120 men who have sex with women who have had a urine swab only. Results will be correlated with sociodemographic and clinical data collected routinely during the consultations. HPV detection and genotyping will be performed using the Anyplex II HPV28 detection assay (Seegene). Results: The first polymerase chain reactions should begin in November 2023. The first results should be submitted for publication in 2024. Conclusions: The study will determine HPV prevalence by age, sex, male sexual preference, human immunodeficiency virus status, and STI co-infection. Collecting data from young patients not usually routinely screened for HPV infection will be a simple and reproducible way of better understanding local specificities, encouraging vaccination campaigns in the short-term, and evaluating their effectiveness in the future. International Registered Report Identifier (IRRID): DERR1-10.2196/47379 ",
doi="10.2196/47379",
url="https://www.researchprotocols.org/2023/1/e47379",
url="http://www.ncbi.nlm.nih.gov/pubmed/37906221"
}


@Article{info:doi/10.2196/46951,
author="Chen, Chia-Chen Angela
and Kim, Wonsun Sunny
and Ou, Lihong
and Todd, Michael
and Larkey, Linda",
title="Digital Storytelling Intervention to Promote Human Papillomavirus Vaccination Among At-Risk Asian Immigrant Populations: Pilot Intervention Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="4",
volume="7",
pages="e46951",
keywords="digital storytelling",
keywords="human papillomavirus",
keywords="immigrants",
keywords="Korean",
keywords="Vietnamese",
keywords="vaccination",
abstract="Background: The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) calls for researchers to address this public health concern through HPV vaccination. Despite disparities in HPV-associated cancers in Korean Americans and Vietnamese Americans, their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve HPV vaccination rates. Digital storytelling (a specific form of cultural narrative) shows promise as an effective culture-centric health promotion strategy. Objective: The aim of this quasi-experimental single-group study was to assess the feasibility, acceptability, and preliminary effects of a culturally and linguistically congruent digital storytelling intervention on Korean American and Vietnamese American mothers' attitudes and intention in vaccinating their children against HPV. We also examined if the association between attitudes and intention differed by their child's sex (boy vs girl) and by ethnicity (Korean American vs Vietnamese American). Methods: Participants were recruited via multiple avenues (eg, ethnic minority community organizations, social media, and flyers posted in local Asian supermarkets and nail salons). Web-based, valid, and reliable measures were administered to collect data preintervention and postintervention. Descriptive statistics, paired and independent sample t tests, the chi-square test, and the McNemar test were used to describe the distributions of variables and to examine the differences between subgroups and changes in key variables over time. Logistic regression models were used to examine associations of mothers' HPV- and vaccine-related attitudes with vaccination intention and to explore if the association between attitudes and vaccination intention differed by the target children's sex or ethnicity. Results: In our sample of 50 Korean American mothers (mean age 42.8, SD 4.8 years) and 114 Vietnamese American mothers (mean age 41.5, SD 5.4 years), 36\% (18/50) of Korean American and 51\% (58/114) of Vietnamese American mothers reported that their children received free or reduced-price lunches at school. After the intervention, mothers' attitudes toward HPV and the vaccine (t163=2.49, P=.01) and intention to vaccinate their children improved significantly (X21=18.38, P<.001). The measure of mothers' negative attitudes toward HPV and the vaccine was significantly associated with higher vaccination intention (odds ratio 0.27, 95\% CI 0.14-0.51; P<.001), adjusting for background variables (sociodemographic characteristics) and other HPV-related variables (family cancer history, prior HPV education, and HPV communication with health care providers). Findings did not suggest that a child's sex or ethnicity moderated the association between attitudes and vaccination intention. Conclusions: This remotely delivered intervention using digital stories was feasible and acceptable, and showed preliminary effects on promoting Korean American and Vietnamese American mothers' intention to vaccinate their children against HPV. Future research that uses a randomized controlled trial design with a larger and more diverse sample and includes children's vaccination status will help understand the effect of the intervention. ",
doi="10.2196/46951",
url="https://formative.jmir.org/2023/1/e46951",
url="http://www.ncbi.nlm.nih.gov/pubmed/36877658"
}


@Article{info:doi/10.2196/38388,
author="Lee, Yun Hee
and Xiong, Serena
and Sur, Aparajita
and Khang, Tounhia
and Vue, Bai
and Culhane-Pera, A. Kathleen
and Pergament, Shannon
and Torres, Beatriz M.
and Koopmeiners, S. Joseph
and Desai, Jay",
title="Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="20",
volume="7",
pages="e38388",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="community-based participatory action research",
keywords="CBPAR",
keywords="eHealth",
keywords="website",
keywords="social cognitive theory",
keywords="Hmong",
keywords="mobile phone",
abstract="Background: Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. Objective: We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. Methods: Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. Results: Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. Conclusions: This theory-driven, community-based participatory action research--designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools). ",
doi="10.2196/38388",
url="https://formative.jmir.org/2023/1/e38388",
url="http://www.ncbi.nlm.nih.gov/pubmed/37338961"
}


@Article{info:doi/10.2196/45696,
author="Kim, Wonsun Sunny
and Chen, Chia-Chen Angela
and Ou, Lihong
and Larkey, Linda
and Todd, Michael
and Han, Yooro",
title="Developing a Culturally and Linguistically Congruent Digital Storytelling Intervention in Vietnamese and Korean American Mothers of Human Papillomavirus--Vaccinated Children: Feasibility and Acceptability Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="14",
volume="7",
pages="e45696",
keywords="Vietnamese",
keywords="Korean",
keywords="Asia",
keywords="cultural",
keywords="digital storytelling",
keywords="storytelling",
keywords="story",
keywords="stories",
keywords="HPV",
keywords="vaccine",
keywords="vaccination",
keywords="feasibility",
keywords="digital intervention",
keywords="mortality rate",
keywords="ratio",
keywords="odd",
keywords="rate",
keywords="deep analysis",
keywords="social media",
keywords="child",
keywords="immigrant",
keywords="mother",
keywords="immunization",
keywords="inoculation",
keywords="inoculate",
keywords="communication",
keywords="culture",
keywords="language",
keywords="human papillomavirus",
keywords="photo",
keywords="video",
keywords="digital",
keywords="microphone",
keywords="conversation",
keywords="dialogue",
keywords="Research Electronic Data Capture",
keywords="voiceover",
keywords="soundtrack",
keywords="writing",
keywords="write",
keywords="script",
keywords="health status",
keywords="health insurance",
keywords="survey",
keywords="questionnaire",
keywords="qualitative",
keywords="constructivist",
keywords="constructivism",
abstract="Background: The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) call for researchers to address this public health concern through HPV vaccination. Disparities of HPV-associated cancers in Vietnamese and Korean Americans exist, yet their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve their HPV vaccination rates. We adopted digital storytelling (DST) that combines oral storytelling with computer-based technology (digital images, audio recording, and music) as a promising approach for facilitating the communication of culturally relevant health messages. Objective: This study aimed to (1) assess the feasibility and acceptability of intervention development through DST workshops, (2) conduct an in-depth analysis of the cultural experience that shapes HPV attitudes, and (3) explore aspects of the DST workshop experience that could inform future formative and intervention work. Methods: Through community partners, social media, and snowball sampling, we recruited 2 Vietnamese American and 6 Korean American mothers (mean age 41.4, SD 5.8 years) who had children vaccinated against HPV. Three virtual DST workshops were conducted between July 2021 and January 2022. Our team supported mothers to develop their own stories. Mothers completed web-based surveys before and after the workshop and provided feedback on each other's story ideas and the workshop experience. We used descriptive statistics to summarize quantitative data and constant comparative analysis to analyze qualitative data collected in the workshop and field notes. Results: Eight digital stories were developed in the DST workshops. They were well accepted, and the mothers showed overall satisfaction and relevant indicators (eg, would recommend it to others, would attend a similar workshop, it was worth their time; mean 4.2-5, range 1-5). Mothers found the process rewarding and appreciated the opportunity to share their stories in group settings and learn from each other. The 6 major themes that emerged from the data reflect the mothers' rich personal experiences, attitudes, and perceptions about their child's HPV vaccination, which included (1) showing parents' love and responsibility; (2) HPV and related knowledge, awareness, and attitudes; (3) factors influencing vaccine decision-making; (4) source of information and information sharing; (5) response to children's being vaccinated; and (6) cultural perspectives on health care and HPV vaccination. Conclusions: Our findings suggest that a virtual DST workshop is a highly feasible and acceptable approach to engaging Vietnamese American and Korean American immigrant mothers in developing culturally and linguistically congruent DST interventions. Further research is needed to test the efficacy and effectiveness of digital stories as an intervention for Vietnamese American and Korean American mothers of unvaccinated children. This process of developing an easy-to-deliver, culturally and linguistically aligned, and holistic web-based DST intervention can be implemented with other populations in other languages. ",
doi="10.2196/45696",
url="https://formative.jmir.org/2023/1/e45696",
url="http://www.ncbi.nlm.nih.gov/pubmed/37314851"
}


@Article{info:doi/10.2196/43041,
author="Cunningham-Erves, Jennifer
and Wilkins, H. Consuelo
and Dempsey, F. Amanda
and Jones, L. Jessica
and Thompson, Chris
and Edwards, Kathryn
and Davis, Megan
and Mayberry, S. Lindsay
and Landsittal, Douglas
and Hull, C. Pamela",
title="Development of a Tailored Mobile Phone--Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="4",
volume="7",
pages="e43041",
keywords="human papillomavirus",
keywords="HPV",
keywords="vaccine",
keywords="hesitancy",
keywords="parent-child communication",
keywords="theory",
keywords="mobile health",
keywords="mHealth",
keywords="adolescents",
keywords="patient education",
abstract="Background: Human papillomavirus (HPV) vaccine hesitancy is on the rise, and provider communication is a first-line strategy to address parental concerns. The use of the presumptive approach and motivational interviewing by providers may not be enough to influence parental decision-making owing to the providers' limited time, self-efficacy, and skills to implement these strategies. Interventions to enhance provider communication and build parental HPV vaccine confidence have been undertested. Delivering tailored patient education to parents via mobile phones before they visit the health care provider may address time constraints during clinic visits and positively affect vaccine uptake. Objective: This study aimed to describe the development and evaluate the acceptability of a mobile phone--based, family-focused intervention guided by theory to address concerns of HPV vaccine--hesitant parents before the clinic visit, as well as explore intervention use to facilitate parent-child communication. Methods: The health belief model and theory of reasoned action guided intervention content development. A multilevel stakeholder engagement process was used to iteratively develop the HPVVaxFacts intervention, including a community advisory board review, a review by an advisory panel comprising HPV vaccine--hesitant parents, a health communications expert review, semistructured qualitative interviews with HPV vaccine--hesitant parents (n=31) and providers (n=15), and a content expert review. Inductive thematic analysis was used to identify themes in the interview data. Results: The qualitative interviews yielded 4 themes: overall views toward mobile device use for health information, acceptability of HPVVaxFacts, facilitators of HPVVaxFacts use, and barriers to HPVVaxFacts use. In parent interviews after reviewing HPVVaxFacts prototypes, almost all parents (29/31, 94\%) stated they intended to have their child vaccinated. Most of the parents stated that they liked the added adolescents' corner to engage in optional parent-child communication (ie, choice to share and discuss information with their child; 27/31, 87\%) and shared decision-making in some cases (8/31, 26\%). After incorporating all input, the final intervention consisted of a 10-item survey to identify the top 3 concerns of parents, followed by tailored education that was mapped to each of the following concerns: evidential messages, images or graphics to enhance comprehension and address low literacy, links to credible websites, a provider video, suggested questions to ask their child's physician, and an optional adolescents' corner to educate the patient and support parent-child communication. Conclusions: The multilevel stakeholder-engaged process used to iteratively develop this novel intervention for HPV vaccine--hesitant families can be used as a model to develop future mobile health interventions. This intervention is currently being pilot-tested in preparation for a randomized controlled trial aiming to increase HPV vaccination among adolescent children of vaccine-hesitant parents in a clinic setting. Future research can adapt HPVVaxFacts for other vaccines and use in other settings (eg, health departments and pharmacies). ",
doi="10.2196/43041",
url="https://formative.jmir.org/2023/1/e43041",
url="http://www.ncbi.nlm.nih.gov/pubmed/37014680"
}


@Article{info:doi/10.2196/42890,
author="Molokwu, Jennifer
and Mendez, Melissa
and Bracamontes, Christina",
title="The Effect of Clinical Decision Prompts in Improving Human Papillomavirus Vaccination Rates in a Multispecialty Practice in a Predominantly Hispanic Population: Quasi-Experimental Study",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="15",
volume="9",
pages="e42890",
keywords="HPV",
keywords="HPV vaccination",
keywords="electronic clinical decision support",
keywords="EMR prompt",
keywords="clinical",
keywords="decision",
keywords="vaccine",
keywords="pediatrics",
keywords="age",
keywords="ethnicity",
keywords="race",
keywords="language",
keywords="immunization",
abstract="Background: The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age. Objective: Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population. Methods: We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015. Results: We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92\% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96\% vs 21.22\%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02\% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7\% and 58.36\%; P<.001). Conclusions: Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92\%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates. ",
doi="10.2196/42890",
url="https://cancer.jmir.org/2023/1/e42890",
url="http://www.ncbi.nlm.nih.gov/pubmed/36920453"
}


@Article{info:doi/10.2196/35601,
author="Duong, Thien Huong
and Hopfer, Suellen",
title="Exploring Intergenerational Communication on Social Media Group Chats as a Cancer Prevention Intervention Opportunity Among Vietnamese American Families: Qualitative Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="15",
volume="7",
pages="e35601",
keywords="cancer prevention",
keywords="Vietnamese",
keywords="family communication",
keywords="intervention",
keywords="colorectal cancer",
keywords="human papillomavirus vaccine",
keywords="HPV vaccine",
keywords="Papanicolaou test",
keywords="mobile phone",
abstract="Background: Families use social media group chats to connect with each other about daily life and to share information. Although cancer is not a frequent topic of conversation in family settings, the adoption of mobile technology in the family context presents a novel opportunity to promote cancer prevention information. To the best of our knowledge, few studies have used private social media group chats to promote cancer prevention information to family members. Objective: In this formative study, we investigated how family group chat platforms can be leveraged to encourage colorectal cancer screening, human papillomavirus vaccination, and cervical cancer screening among intergenerational Vietnamese American families. This study aimed to cocreate a family-based communication intervention for introducing cancer screening information in family group chats. We sought to understand family members' motivations for using group chats, family dynamics and conversation patterns, and group chat experiences and cultural norms for interacting with family members. Methods: Overall, 20 audio-recorded and semistructured interviews were conducted with young Vietnamese adults. The study was conducted between August and October 2018. Participants were Vietnamese Americans; aged between 18 and 44 years; living in Orange County, California; had an existing family group chat; and expressed an interest in becoming family health advocates. Data were analyzed using a framework analysis. Results: In total, 13 (65\%) of the 20 young adults reported having >1 group chat with their immediate and extended family. Preventive health was not a typical topic of family conversations, but food, family announcements, personal updates, humorous videos or photos, and current events were. Young adults expressed openness to initiating conversations with family members about cancer prevention; however, they also raised concerns that may influence family members' receptivity to the messages. Themes that could potentially impact family members' willingness to accept cancer prevention messages included family status and hierarchy, gender dynamics, relational closeness in the family, and source trust and credibility. These considerations may impact whether families will be open to receiving cancer screening information and acting on it. The participants also mentioned practical considerations for intervention and message design, which included the Vietnamese cultural conversation etiquette of h?i th?m, respect for a physician's recommendation, prevention versus symptom orientation, the family health advocate's bilingual capacity, and the busy lives of family members. In response to exemplar messages, participants mentioned that they preferred to personalize template messages to accommodate conversational norms in their family group chats. Conclusions: The findings of this study inform the development of a social media intervention for increasing preventive cancer screening in Vietnamese American families. ",
doi="10.2196/35601",
url="https://formative.jmir.org/2023/1/e35601",
url="http://www.ncbi.nlm.nih.gov/pubmed/36790844"
}


@Article{info:doi/10.2196/37559,
author="Kim, Jung Sunny
and Schiffelbein, E. Jenna
and Imset, Inger
and Olson, L. Ardis",
title="Countering Antivax Misinformation via Social Media: Message-Testing Randomized Experiment for Human Papillomavirus Vaccination Uptake",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="24",
volume="24",
number="11",
pages="e37559",
keywords="misinformation",
keywords="vaccine hesitancy",
keywords="vaccine communication",
keywords="social media",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
abstract="Background: Suboptimal adolescent human papillomavirus (HPV) vaccination rates have been attributed to parental perceptions of the HPV vaccine. The internet has been cited as a setting where misinformation and controversy about HPV vaccination have been amplified. Objective: We aimed to test message effectiveness in changing parents' attitudes and behavioral intentions toward HPV vaccination. Methods: We conducted a web-based message-testing experiment with 6 control messages and 25 experimental messages and 5 from each of the 5 salient themes about HPV vaccination (theme 1: safety, side effects, risk, and ingredient concerns and long-term or major adverse events; theme 2: distrust of the health care system; theme 3: HPV vaccine effectiveness concerns; theme 4: connection to sexual activity; and theme 5: misinformation about HPV or HPV vaccine). Themes were identified from previous web-based focus group research with parents, and specific messages were developed by the study team using content from credible scientific sources. Through an iterative process of message development, the messages were crafted to be appropriate for presentation on a social media platform. Among the 1713 participants recruited via social media and crowdsourcing sites, 1043 eligible parents completed a pretest survey questionnaire. Participants were then randomly assigned to 1 of the 31 messages and asked to complete a posttest survey questionnaire that assessed attitudes toward the vaccine and perceived effectiveness of the viewed message. A subgroup of participants (189/995, 19\%) with unvaccinated children aged 9 to 14 years was also assessed for their behavioral intention to vaccinate their children against HPV. Results: Parents in the experimental group had increased positive attitudes toward HPV vaccination compared with those in the control group (t969=3.03, P=.003), which was associated with increased intention to vaccinate among parents of unvaccinated children aged 9 to 14 years (r=1.14, P=.05). At the thematic level, we identified 4 themes (themes 2-5) that were relatively effective in increasing behavioral intentions by positively influencing attitudes toward the HPV vaccine ($\chi$25=5.97, P=.31, root mean square error of approximation [RMSEA]=0.014, comparative fit index [CFI]=0.91, standardized root mean square residual [SRMR]=0.031). On the message level, messages that provided scientific evidence from government-related sources (eg, the Centers for Disease Control and Prevention) and corrected misinformation (eg, ``vaccines like the HPV vaccine are simply a way for pharmaceutical companies to make money. That isn't true'') were effective in forming positive perceptions toward the HPV vaccination messages. Conclusions: Evidence-based messages directly countering misinformation and promoting HPV vaccination in social media environments can positively influence parents' attitudes and behavioral intentions to vaccinate their children against HPV. ",
doi="10.2196/37559",
url="https://www.jmir.org/2022/11/e37559",
url="http://www.ncbi.nlm.nih.gov/pubmed/36422887"
}


@Article{info:doi/10.2196/38164,
author="Darville-Sanders, Gabrielle
and Reinoso, Humberto
and MacInnes, Jann
and Corluyan, Emilie
and Munroe, Dominique
and Mathis, W. Mary
and Madden, Lamarca Suzie
and Hamrick, Johnathan
and Dickerson, Lisa
and Gaddis, Cheryl",
title="HPV Vaccine Communication Competency Scale for Medical Trainees: Interdisciplinary Development Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e38164",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="provider communication",
keywords="medical trainees",
keywords="immunization",
keywords="vaccine",
keywords="communication",
keywords="student",
keywords="sexually transmitted infection",
keywords="STI",
keywords="United States of America",
keywords="USA",
keywords="young adult",
keywords="teen",
keywords="patient",
keywords="parent",
keywords="mobile phone",
abstract="Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States. High-risk HPV strains are associated with cancer of the cervix, oropharynx, anus, rectum, penis, vagina, and vulva. To combat increasing HPV-related cancers, the 9-valent HPV vaccine Gardasil was developed. Recommendation of the HPV vaccine by a health care provider has been cited as the number one factor affecting vaccine uptake among adolescents and young adults. Physician assistants, nurse practitioners, and pharmacists have been enlisted to bridge the gap. Objective: The specific aim of this research study was to develop a reliable and valid HPV vaccine communication scale that can be used to measure the competency of primary care providers when recommending the need for vaccination to parents and patients. Methods: Using a descriptive study, we collected data via a literature review, focus groups, and an expert panel to inform the scale domains and blueprint design. Pretesting (cognitive interviews) was used to inform item revision decisions. An item analysis was also conducted for the responses provided in the cognitive interviews. Item statistics (means and SDs), interitem correlations, and reliability were examined. Data were analyzed using SPSS (IBM Corp) software. Results: A valid and reliable 42-item HPV vaccine communication competency scale was developed. The scale included 6 domains of interest. Scale items were moderately to strongly correlated with one another, and Cronbach $\alpha$ indicated good internal consistency with each scale. Scale items included were related to provider introduction or rapport ($\alpha$=.796), patient respect or empathy ($\alpha$=.737), provider interview or intake ($\alpha$=.9), patient counseling or education ($\alpha$=.935), provider communication closure ($\alpha$=.896), and provider knowledge ($\alpha$=.824). Conclusions: Pharmacists, nurse practitioners, and physician assistants should be trained to be competent in HPV vaccine communication and recommendation due to their expanded roles. Interdisciplinary collaboration is important to account for the trainee's individual differences and ensure the best health care outcomes for patients. A standardized HPV communication scale can be used to ensure effective and consistent recommendation by health care providers, thus affecting immunization rates. ",
doi="10.2196/38164",
url="https://formative.jmir.org/2022/11/e38164",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331545"
}


@Article{info:doi/10.2196/37848,
author="Si, Mingyu
and Su, Xiaoyou
and Jiang, Yu
and Wang, Wenjun
and Zhang, Xi
and Gu, Xiaofen
and Ma, Li
and Li, Jing
and Zhang, Shaokai
and Ren, Zefang
and Liu, Yuanli
and Qiao, Youlin",
title="An Internet-Based Education Program for Human Papillomavirus Vaccination Among Female College Students in Mainland China: Application of the Information-Motivation-Behavioral Skills Model in a Cluster Randomized Trial",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="30",
volume="24",
number="9",
pages="e37848",
keywords="human papillomavirus vaccination",
keywords="internet-based education",
keywords="information-motivation-behavioral skills model",
keywords="female college students",
keywords="China",
abstract="Background: Patients diagnosed with cervical cancer in the last 2 decades were mainly young females. Human papillomavirus (HPV) vaccination is the most radical way to prevent HPV infection and cervical cancer. However, most female college students in mainland China have not yet been vaccinated, and their relevant knowledge is limited. Theory-based education delivered via the internet is a potentially accessible and useful way to promote HPV vaccination among this population. Objective: This 3-month follow-up study intended to identify the feasibility and efficacy of an information-motivation-behavioral skills (IMB) model--based online intervention for promoting awareness and willingness regarding HPV vaccination among female college students. Methods: A 7-day online HPV education program for female college students in mainland China was developed using a cluster randomized trial design. Recruitment and questionnaire surveys were performed online without face-to-face contact. SPSS 23.0 was used for statistical analysis. The chi-square test and t test were used to compare differences in qualitative and continuous variables between intervention and control groups. The generalized estimating equation was used to test the effectiveness of the intervention with a consideration of the time factor. Results: Among 3867 participants, 102 had been vaccinated against HPV before the study (vaccination rate of 2.6\%). A total of 3484 participants were followed up after the baseline survey, with no statistical difference in the loss rate between the intervention and control groups during the intervention and follow-up periods. At different follow-up time points, HPV-related knowledge, and the motivation, behavioral skills, and willingness regarding HPV vaccination were higher in the intervention group than in the control group. HPV-related knowledge was statistically different between the 2 groups, while the motivation, behavioral skills, and willingness regarding HPV vaccination only showed statistical differences right after the intervention, reaching a peak right after the intervention and then gradually reducing over time. Furthermore, there was no statistical difference in the HPV vaccination rate between the 2 groups. Conclusions: IMB model--based online education could be a promising way to increase the HPV vaccination rate and reduce the burden of HPV infection and cervical cancer among high-risk female college students in China. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900025476; http://www.chictr.org.cn/showprojen.aspx? proj=42672 International Registered Report Identifier (IRRID): RR2-DOI:10.1186/s12889-019-7903-x ",
doi="10.2196/37848",
url="https://www.jmir.org/2022/9/e37848",
url="http://www.ncbi.nlm.nih.gov/pubmed/36178723"
}


@Article{info:doi/10.2196/37274,
author="Jo, Soojung
and Pituch, A. Keenan
and Howe, Nancy",
title="The Relationships Between Social Media and Human Papillomavirus Awareness and Knowledge: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Sep",
day="20",
volume="8",
number="9",
pages="e37274",
keywords="papillomavirus infections",
keywords="vaccination",
keywords="social media",
keywords="health promotion",
keywords="public reporting of health care data",
keywords="human papillomavirus",
abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV can infect both females and males, and it can cause many cancers, including anal, cervical, vaginal, vulvar, and penile cancers. HPV vaccination rates are lower than vaccination rates within other national vaccination programs, despite its importance. Research literature indicates that people obtain health-related information from internet sources and social media; however, the association between such health-seeking behavior on social media and HPV-related behaviors has not been consistently demonstrated in the literature. Objective: This study aims to examine the association between social media usage and HPV knowledge and HPV awareness. Methods: This study analyzed public health data collected through the Health Information National Trends Survey (HINTS) conducted by the US National Cancer Institute. The analysis used data collected in 2020; in total, 2948 responses were included in the analysis. Six HPV-related questions were used to identify HPV awareness, HPV vaccine awareness, and HPV knowledge about HPV-related cancers. Four questions about social media usage and one question about online health information--seeking behavior were used to analyze the associations between social media usage and HPV-related behaviors. Initially, six logistic regressions were conducted using replicate weights. Based on the results, significant factors were included in a second set of regression analyses that also included demographic variables. Results: About half of the respondents were aware of HPV (68.40\%), the HPV vaccine (64.04\%), and the relationship between HPV and cervical cancer (48.00\%). However, fewer respondents were knowledgeable about the relationships between HPV and penile cancer (19.18\%), anal cancer (18.33\%), and oral cancer (19.86\%). Although social media usage is associated with HPV awareness, HPV vaccine awareness, and knowledge of cervical cancer, these associations were not significant after adjusting for demographic variables. Those less likely to report HPV awareness and knowledge included older participants, males, those with a household income of less than US \$20,000, those with a formal education equal to or less than high school, or those who resided in a household where adults are not fluent in English. Conclusions: After adjusting for demographic variables, social media use was not related to HPV knowledge and awareness, and survey respondents were generally not aware that HPV can lead to specific types of cancer, other than cervical cancer. These results suggest that perhaps a lack of high-quality information on social media may impede HPV awareness and knowledge. Efforts to educate the public about HPV via social media might be improved by using techniques like storytelling or infographics, especially targeting vulnerable populations, such as older participants, males, those with low incomes, those with less formal education, or those who reside in the United States but are not fluent in English. ",
doi="10.2196/37274",
url="https://publichealth.jmir.org/2022/9/e37274",
url="http://www.ncbi.nlm.nih.gov/pubmed/36125858"
}


@Article{info:doi/10.2196/38297,
author="Thompson, L. Erika
and Preston, M. Sharice
and Francis, R. Jenny K.
and Rodriguez, A. Serena
and Pruitt, L. Sandi
and Blackwell, James-Michael
and Tiro, A. Jasmin",
title="Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey",
journal="JMIR Pediatr Parent",
year="2022",
month="Sep",
day="14",
volume="5",
number="3",
pages="e38297",
keywords="HPV vaccination",
keywords="human papillomavirus",
keywords="social media",
keywords="decision-making",
keywords="vaccination",
keywords="teens",
keywords="adolescents",
keywords="parent",
keywords="USA",
keywords="United States",
keywords="misinformation",
keywords="internet",
keywords="survey",
keywords="unvaccinated",
keywords="child",
keywords="online",
keywords="health",
keywords="literacy",
keywords="decision",
keywords="health care",
keywords="teen",
keywords="vaccine",
abstract="Background: Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. Objective: This study aimed to examine the association between parents' perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. Methods: Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. Results: Of the 1192 respondents, 44.7\% (n=533) had an HPV-vaccinated child, 38.8\% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4\% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be ``undecided/not wanting the vaccine'' if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95\% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95\% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95\% CI 0.62-0.88; P<.001). Conclusions: Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions. ",
doi="10.2196/38297",
url="https://pediatrics.jmir.org/2022/3/e38297",
url="http://www.ncbi.nlm.nih.gov/pubmed/36103216"
}


@Article{info:doi/10.2196/37656,
author="Bhagavathula, Srikanth Akshaya
and Massey, M. Philip",
title="Google Trends on Human Papillomavirus Vaccine Searches in the United States From 2010 to 2021: Infodemiology Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Aug",
day="29",
volume="8",
number="8",
pages="e37656",
keywords="Google Trends",
keywords="HPV vaccine",
keywords="Google search",
keywords="attitude",
keywords="infodemiology",
keywords="searches",
keywords="United States of America",
abstract="Background: The human papillomavirus (HPV) vaccine is recommended for adolescents and young adults to prevent HPV-related cancers and genital warts. However, HPV vaccine uptake among the target age groups is suboptimal. Objective: The aim of this infodemiology study was to examine public online searches in the United States related to the HPV vaccine from January 2010 to December 2021. Methods: Google Trends (GT) was used to explore online searches related to the HPV vaccine from January 1, 2010, to December 31, 2021. Online searches and queries on the HPV vaccine were investigated using relative search volumes (RSVs). Analysis of variance was performed to investigate quarterly differences in HPV vaccine searches in each year from 2010 to 2021. A joinpoint regression was used to identify statistically significant changes over time; the $\alpha$ level was set to .05. Results: The year-wise online search volume related to the HPV vaccine increased from 2010 to 2021, often following federal changes related to vaccine administration. Joinpoint regression analysis showed that HPV vaccine searches significantly increased on average by 8.6\% (95\% CI 5.9\%-11.4\%) across each year from 2010 to 2021. Moreover, HPV vaccine searches demonstrated a similar pattern across years, with search interest increasing through August nearly every year. At the state level, the highest 12-year mean RSV was observed in California (59.9, SD 14.3) and the lowest was observed in Wyoming (17.4, SD 8.5) during the period of 2010-2021. Conclusions: Online searches related to the HPV vaccine increased by an average of 8.6\% across each year from 2010 to 2021, with noticeable spikes corresponding to key changes in vaccine recommendations. We identified patterns across years and differences at the state level in the online search interest related to the HPV vaccine. Public health organizations can use GT as a tool to characterize the public interest in and promote the HPV vaccine in the United States. ",
doi="10.2196/37656",
url="https://publichealth.jmir.org/2022/8/e37656",
url="http://www.ncbi.nlm.nih.gov/pubmed/36036972"
}


@Article{info:doi/10.2196/35695,
author="Tran, Lien Phuong
and Chirpaz, Emmanuel
and Boukerrou, Malik
and Bertolotti, Antoine",
title="Impact of a Papillomavirus Vaccination Promotion Program in Middle School: Study Protocol for a Cluster Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="13",
volume="11",
number="6",
pages="e35695",
keywords="HPV vaccine",
keywords="vaccination program",
keywords="middle school",
keywords="school",
keywords="student",
keywords="women's health",
keywords="sexual health",
keywords="cervical cancer",
keywords="vaccination",
keywords="papillomavirus",
keywords="vaccine",
keywords="public education",
keywords="patient education",
keywords="community education",
keywords="promotion",
keywords="program",
keywords="youth",
keywords="children",
keywords="protocol",
keywords="mortality",
keywords="uterine cervical cancer",
keywords="cancer",
keywords="HPV",
keywords="health promotion",
keywords="girls",
keywords="intervention",
keywords="parent",
keywords="training",
abstract="Background: On Reunion Island, incidence and mortality for uterine cervical cancer is high, yet coverage rate for human papillomavirus (HPV) vaccination is low. Objective: The main objective of the study is to evaluate the impact of a health promotion program promoting HPV vaccination on the proportion of middle school girls who complete the full HPV vaccination schedule (2 or 3 doses) by the end of school year. Methods: This study is a cluster controlled intervention study using a superiority design. A combined health promotion program will be offered containing information to students and parents, training of general practitioners, and free school-based vaccination (in a ``health bus''). Children who attend this program will constitute the intervention group and will be compared to children from another middle school who will not attend the program constituting the control group. Results: Recruitment began in October 2020. In the intervention school, of 780 students, 245 were randomly selected in the 12 classes. In the control school, 259 students out of 834 were randomly selected. Conclusions: In this study, we explore the impact of a health promotion program combining information toward students, parents, and general practitioners with free school-based vaccination. We expect a significantly higher HPV vaccination coverage in the intervention school as compared to the control school, whether it be among girls or boys. The final implication would be an extension of this program in all middle schools on the Island and thus an increase in HPV vaccination coverage. Trial Registration: ClinicalTrials.gov NCT04459221; https://clinicaltrials.gov/ct2/show/NCT04459221 International Registered Report Identifier (IRRID): DERR1-10.2196/35695 ",
doi="10.2196/35695",
url="https://www.researchprotocols.org/2022/6/e35695",
url="http://www.ncbi.nlm.nih.gov/pubmed/35700023"
}


@Article{info:doi/10.2196/34715,
author="Suzuki, Yukio
and Sukegawa, Akiko
and Ueda, Yutaka
and Sekine, Masayuki
and Enomoto, Takayuki
and Melamed, Alexander
and Wright, D. Jason
and Miyagi, Etsuko",
title="The Effect of a Web-Based Cervical Cancer Survivor's Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="25",
volume="8",
number="5",
pages="e34715",
keywords="human papilloma virus vaccination",
keywords="vaccination",
keywords="vaccine",
keywords="vaccine hesitancy",
keywords="cancer survivor",
keywords="narrative story",
keywords="web based",
keywords="randomized controlled trial",
keywords="RCT",
keywords="HPV",
keywords="human papilloma virus",
keywords="virus",
keywords="hesitancy",
keywords="cancer",
keywords="willingness",
keywords="behavior",
keywords="parent",
abstract="Background: Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective: The aim of this trial is to assess the effect of a cervical cancer survivor's story on the willingness of parents to get HPV vaccination for their daughters. Methods: In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results: Of 2175 participants, 1266 (58.2\%) were men and 909 (41.8\%) were women. A total of 191 (8.8\%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6\%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8\%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9\%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5\% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95\% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95\% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95\% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1\%) participants responded. Of these, 149 (8.2\%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9\%) in the intervention group and 72 (8.7\%) in the control group. Conclusions: A cervical cancer survivor's story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf ",
doi="10.2196/34715",
url="https://publichealth.jmir.org/2022/5/e34715",
url="http://www.ncbi.nlm.nih.gov/pubmed/35421848"
}


@Article{info:doi/10.2196/34070,
author="Shin, Hyunjeong
and Jeon, Songi
and Cho, Inhae
and Park, HyunJi",
title="Factors Affecting Human Papillomavirus Vaccination in Men: Systematic Review",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="26",
volume="8",
number="4",
pages="e34070",
keywords="health service use",
keywords="men",
keywords="papillomavirus",
keywords="papillomavirus vaccines",
keywords="systematic review",
keywords="vaccination",
keywords="vaccine",
keywords="HPV",
keywords="review",
keywords="gender",
abstract="Background: Despite the high risks associated with human papillomavirus (HPV), the HPV vaccination rate of men is far lower than women. Most previous review studies have focused on female vaccination and related affecting factors. However, previous studies have reported that the factors affecting HPV vaccination differ by gender. Objective: The aim of this review was to identify the factors affecting HPV vaccine initiation in men through a systematic review approach. Methods: A literature review was conducted across 3 central electronic databases for relevant articles. A total of 30 articles published between 2013 and 2019 met the inclusion criteria and were reviewed in this study. Results: In total, 50 factors affecting HPV vaccination in men were identified, including 13 sociodemographic factors and social structure factors, 12 belief-related variables, 4 family factors, 4 community factors, 14 variables related to needs, and 3 environmental factors. Conclusions: To increase HPV vaccination rates in men, strategies targeting young males and their families should consider frequent visits to or contact with health care providers so that health care professionals can provide recommendations for HPV vaccination. ",
doi="10.2196/34070",
url="https://publichealth.jmir.org/2022/4/e34070",
url="http://www.ncbi.nlm.nih.gov/pubmed/35471242"
}


@Article{info:doi/10.2196/28676,
author="Occa, Aurora
and Stahl, M. Hayley
and Julien-Bell, Sarah",
title="Helping Children to Participate in Human Papillomavirus--Related Discussions: Mixed Methods Study of Multimedia Messages",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="11",
volume="6",
number="4",
pages="e28676",
keywords="animation",
keywords="game",
keywords="HPV",
keywords="child-parent communication",
keywords="child-physician communication",
keywords="pilot study",
keywords="children",
keywords="health communication",
keywords="communication technologies",
keywords="vaccination",
keywords="health education",
abstract="Background: Human papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children). Objective: This manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health---in particular when such conversations center around the HPV vaccination---and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children's knowledge and perceptions of HPV prevention. Methods: A mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children's experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials. Results: Both the animated video and a web-based game increased children's knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements. Conclusions: This study shows that both materials were effective for improving children's education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns. ",
doi="10.2196/28676",
url="https://formative.jmir.org/2022/4/e28676",
url="http://www.ncbi.nlm.nih.gov/pubmed/35404265"
}


@Article{info:doi/10.2196/30340,
author="Becker, RB Elisabeth
and Shegog, Ross
and Savas, S. Lara
and Frost, L. Erica
and Coan, P. Sharon
and Healy, Mary C.
and Spinner, W. Stanley
and Vernon, W. Sally",
title="Parents' Experience With a Mobile Health Intervention to Influence Human Papillomavirus Vaccination Decision Making: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Feb",
day="21",
volume="5",
number="1",
pages="e30340",
keywords="human papillomavirus",
keywords="vaccination",
keywords="user experience",
keywords="parent",
keywords="mHealth",
keywords="HPV",
keywords="vaccine",
keywords="HPV vaccine",
keywords="parenting",
keywords="pediatrics",
keywords="sexual health",
keywords="cervical cancer",
keywords="adolescents",
keywords="app",
keywords="application",
abstract="Background: Human papillomavirus (HPV)-attributed cancers are preventable, yet HPV vaccination rates severely lag behind other adolescent vaccinations. HPVcancerFree (HPVCF) is a mobile health (mHealth) intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers, and enabling HPV vaccination scheduling and reminders through a smartphone app. Evaluating the user experience of mHealth interventions is a vital component in assessing their quality and success but tends to be underreported in mHealth intervention evaluation. Objective: We aimed to evaluate the user experience of HPVCF, an HPV cancer prevention app designed for a pediatric clinic network, using mixed methods data collected from log files, survey measures, and qualitative feedback. Methods: Study data were evaluated from parents in a large US pediatric clinic network using HPVCF in the treatment study condition of a group randomized controlled trial. Log data captured HPVCF retention and use. Postintervention rating scales and items assessed HPVCF utility, usefulness, understandability, appeal, credibility, and perceived impact. Overall quality was evaluated using the user version of the Mobile Application Rating Scale (uMars). Open-ended responses assessed parent recommendations for HPVCF enhancement. Results: The 98 parents were mainly female (n=94, 96\%), 41 (5.67) years of age, college educated (n=55, 56\%), and White and non-Hispanic (n=55, 56\%) and had private health insurance for their children (n=75, 77\%). Parents used HPVCF 197 times, with the average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5.0). Mean ratings were highest for information (4.46 [SD 0.53]) and lowest for engagement (3.74 [SD 0.69]). In addition, of 95 parents, 45 (47\%) rated HPVCF as helpful in HPV vaccination decision making and 16 (17\%) attributed HPV vaccine initiation to HPVCF. Parents reported that HPVCF increased their awareness (84/95, 88\%), knowledge (84/95, 88\%), and HPV vaccination intentions (64/95, 67\%). Most of the 98 parents rated the 4 HPVCF components as useful (72-92 [73\%-94\%]). Parents also agreed that HPVCF is clear (86/95, 91\%), accurate (86/95, 91\%), and more helpful than other HPV vaccine information they had received (89/95, 94\%) and that they would recommend it to others (81/95, 85\%). In addition, parents suggested ways to increase awareness and engagement with the app, along with opportunities to enhance the content and functionality. Conclusions: HPVCF was well received by parents and performed well on indicators of quality, usefulness, utility, credibility, and perceived impact. This study contributes a multimethod and multimeasure evaluation to the growing body of literature focused on assessing the user experience of patient-focused technology-mediated applications for HPV education. ",
doi="10.2196/30340",
url="https://pediatrics.jmir.org/2022/1/e30340",
url="http://www.ncbi.nlm.nih.gov/pubmed/35188469"
}


@Article{info:doi/10.2196/26356,
author="Wynn, S. Chelsea
and Catallozzi, Marina
and Kolff, A. Chelsea
and Holleran, Stephen
and Meyer, Dodi
and Ramakrishnan, Rajasekhar
and Stockwell, S. Melissa",
title="Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="27",
volume="9",
number="12",
pages="e26356",
keywords="text messaging",
keywords="mobile reminders",
keywords="human papillomavirus",
keywords="adolescent",
keywords="text reminders",
keywords="vaccine completion",
keywords="vaccine decision-making",
keywords="vaccine education",
keywords="transtheoretical model",
keywords="mobile phone",
keywords="smartphone",
keywords="mHealth",
keywords="mobile health",
keywords="minority health",
abstract="Background: Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. SMS text message vaccine reminders are effective, but less is known about the best types for HPV series completion or the ability to assess and target vaccine decision-making stage. Objective: The aim of this study is to compare the effectiveness of HPV vaccine series completion in minority adolescents who received precision and educational versus conventional SMS text message reminders. Methods: Enrolled parents of adolescents aged 9-17 years who received the first HPV vaccine dose at 1 of the 4 academic-affiliated community health clinics in New York City were randomized 1:1 to 1 of the 2 parallel, unblinded arms: precision SMS text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional SMS text messages without educational information. Randomization was stratified according to gender, age, and language. The primary outcome was series completion within 12 months. In post hoc analysis, enrollees were compared with concurrent nonenrollees and historical controls. Results: Overall, 956 parents were enrolled in the study. The precision (475 families) and conventional (481 families) SMS text message arms had similarly high series completion rates (344/475, 72.4\% vs 364/481, 75.7\%). A total of 42 days after the first dose, two-thirds of families, not initially in the preparation stage, moved to preparation or vaccinated stage. Those in either SMS text message arm had significantly higher completion rates than nonenrollees (708/1503, 47.1\% vs 679/1503, 45.17\%; P<.001). Even after removing those needing only 2 HPV doses, adolescents receiving any SMS text messages had higher completion rates than historical controls (337/2823, 11.93\% vs 981/2823, 34.75\%; P<.001). A population-wide effect was seen from 2014 to 2016, above historical trends. Conclusions: SMS text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population and also led to population-wide effects. Educational information did not provide an added benefit to this population. Trial Registration: ClinicalTrials.gov NCT02236273; https://clinicaltrials.gov/ct2/show/NCT02236273 ",
doi="10.2196/26356",
url="https://mhealth.jmir.org/2021/12/e26356",
url="http://www.ncbi.nlm.nih.gov/pubmed/34958306"
}


@Article{info:doi/10.2196/32407,
author="Chow, PF Eric
and Fairley, K. Christopher
and Wigan, Rebecca
and Hocking, S. Jane
and Garland, M. Suzanne
and Cornall, M. Alyssa
and Tabrizi, N. Sepehr
and Chen, Y. Marcus",
title="Accuracy of Self-reported Human Papillomavirus Vaccination Status Among Gay and Bisexual Adolescent Males: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="6",
volume="7",
number="12",
pages="e32407",
keywords="human papillomavirus",
keywords="vaccination",
keywords="accuracy",
keywords="self-reported",
keywords="men who have sex with men",
keywords="immunisation",
keywords="public health",
keywords="immunization",
keywords="HPV vaccination",
keywords="bisexual adolescents",
keywords="bisexual men",
abstract="Background: Men who have sex with men are a risk group for anal human papillomavirus (HPV) and anal cancer. Australia introduced a universal school-based HPV vaccination program in 2013. Self-reported HPV vaccination status has been widely used in clinical and research settings, but its accuracy is understudied. Objective: We aimed to examine the accuracy of self-reported HPV vaccination status among gay and bisexual adolescent males. Methods: We included 192 gay and bisexual males aged 16-20 years from the Human Papillomavirus in Young People Epidemiological Research 2 (HYPER2) study in Melbourne, Australia. All participants had been eligible for the universal school-based HPV vaccination program implemented in 2013 and were asked to self-report their HPV vaccination status. Written informed consent was obtained to verify their HPV vaccination status using records at the National HPV Vaccination Program Register and the Australian Immunisation Register. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of self-reported HPV vaccination status. Results: The median age of the 192 males was 19 (IQR 18-20) years. There were 128 males (67\%) who had HPV vaccination records documented on either registry. Self-reported HPV vaccination had a sensitivity of 47.7\% (95\% CI 38.8\%-56.7\%; 61/128), a specificity of 85.9\% (95\% CI 75.0\%-93.4\%; 55/64), a positive predictive value of 87.1\% (95\% CI 77.0\%-93.9\%; 61/70), and a negative predictive value of 45.1\% (95\% CI 36.1\%-54.3\%; 55/122). Conclusions: Self-reported HPV vaccination status among Australian gay and bisexual adolescent males underestimates actual vaccination and may be inaccurate for clinical and research purposes. ",
doi="10.2196/32407",
url="https://publichealth.jmir.org/2021/12/e32407",
url="http://www.ncbi.nlm.nih.gov/pubmed/34874884"
}


@Article{info:doi/10.2196/28846,
author="Becker, RB Elisabeth
and Shegog, Ross
and Savas, S. Lara
and Frost, L. Erica
and Healy, Mary C.
and Spinner, W. Stanley
and Vernon, W. Sally",
title="Informing Content and Feature Design of a Parent-Focused Human Papillomavirus Vaccination Digital Behavior Change Intervention: Synchronous Text-Based Focus Group Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="19",
volume="5",
number="11",
pages="e28846",
keywords="human papillomavirus",
keywords="vaccination",
keywords="qualitative",
keywords="focus groups",
keywords="sexually transmitted infection",
abstract="Background: Human papillomavirus (HPV) is a common and preventable sexually transmitted infection; however, vaccination rates in the United States among the target age group, which is 11-12 years, are lower than national goals. Interventions that address the barriers to and facilitators of vaccination are important for improving HPV vaccination rates. Web-based, text-based focus groups are becoming a promising method that may be well suited for conducting formative research to inform the design of digital behavior change intervention (DBCI) content and features that address HPV vaccination decision-making. Objective: This study aims to explore parental HPV vaccination decision-making processes using a web-based, text-based focus group protocol to inform content and feature recommendations for an HPV prevention DBCI. Methods: We conducted 4 web-based, text-based synchronous focus groups via Skype with the parents of patients aged 11-13 years within a large urban US pediatric clinic network. Results: The 22 parents were mostly female, White, non-Hispanic college graduates, and they mostly had private health insurance for their children. Approximately half (14/25, 56\%) of the parents' 11-13 year old children had initiated HPV vaccination. Most parents had experience using Skype (19/22, 86\%). Approximately half (8/17, 47\%) of parents expressed no preference for the focus group format, whereas 47\% (8/17) requested a text-only chat format and 6\% (1/17) requested an audiovisual format. The three main themes from the qualitative data were barriers to HPV vaccination, facilitators of HPV vaccination, and suggestions for improving the HPV vaccination clinic experience. A total of 11 intervention content and feature recommendations emerged from the themes, including addressing HPV knowledge barriers using trusted sources, designing for a family audience, focusing on the framing of messages, reporting reputable HPV research in a comprehensible format, and expanding the clinic visit experience. Conclusions: Synchronous text-based focus groups are feasible for conducting formative research on HPV vaccination decision-making. Among well-educated and well-resourced parents, there are barriers such as misinformation and facilitators such as pediatrician recommendations that influence HPV vaccination decision-making. Parents want to conduct their own HPV research as well as receive relevant HPV vaccination advice from their child's pediatrician. In addition, parents want an enhanced clinic visit experience that lets them access and connect to tailored information before and after clinic visits. The results gathered provide guidance for content and features that may inform a more responsive DBCI to address HPV vaccination decision-making among parents. ",
doi="10.2196/28846",
url="https://formative.jmir.org/2021/11/e28846",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806991"
}


@Article{info:doi/10.2196/29885,
author="Li, Jinhui
and Zheng, Han
and Duan, Xu",
title="Factors Influencing the Popularity of a Health-Related Answer on a Chinese Question-and-Answer Website: Case Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="28",
volume="23",
number="9",
pages="e29885",
keywords="answer-response behaviors",
keywords="Zhihu",
keywords="HPV vaccine information",
keywords="content features",
keywords="context features",
keywords="contributor features",
abstract="Background: Social question-and-answer (Q\&A) sites have become an important venue for individuals to obtain and share human papillomavirus (HPV) vaccine knowledge. Objective: This study aims to examine how different features of an HPV vaccine--related answer are associated with users' response behaviors on social Q\&A websites. Methods: A total of 2953 answers and 270 corresponding questions regarding the HPV vaccine were collected from a leading Chinese social Q\&A platform, Zhihu. Three types of key features, including content, context, and contributor, were extracted and coded. Negative binomial regression models were used to examine their impact on the vote and comment count of an HPV vaccine--related answer. Results: The findings showed that both content length and vividness were positively related to the response behaviors of HPV vaccine--related answers. In addition, compared with answers under the question theme benefits and risks, answers under the question theme vaccination experience received fewer votes and answers under the theme news opinions received more votes but fewer comments. The effects of characteristics of contributors were also supported, suggesting that answers from a male contributor with more followers and no professional identity would attract more votes and comments from community members. The significant interaction effect between content and context features further showed that long and vivid answers about HPV vaccination experience were more likely to receive votes and comments of users than those about benefits and risks. Conclusions: The study provides a complete picture of the underlying mechanism behind response behaviors of users toward HPV vaccine--related answers on social Q\&A websites. The results help health community organizers develop better strategies for building and maintaining a vibrant web-based community for communicating HPV vaccine knowledge. ",
doi="10.2196/29885",
url="https://www.jmir.org/2021/9/e29885",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581675"
}


@Article{info:doi/10.2196/28355,
author="Suzuki, Yukio
and Sukegawa, Akiko
and Ueda, Yutaka
and Sekine, Masayuki
and Enomoto, Takayuki
and Miyagi, Etsuko",
title="Effect of a Brief Web-Based Educational Intervention on Willingness to Consider Human Papillomavirus Vaccination for Children in Japan: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="27",
volume="23",
number="9",
pages="e28355",
keywords="human papillomavirus",
keywords="human papillomavirus vaccination",
keywords="behavioral insights",
keywords="behavioral change",
keywords="web-based randomized controlled trial",
abstract="Background: The human papillomavirus (HPV) vaccination rate in Japan has fallen to nearly zero since the suspension of governmental proactive recommendations in 2013, owing to the development of purported adverse events. Objective: This study aimed to evaluate the effects of a brief web-based educational intervention using the theory of behavioral insights on the willingness of adults to consider the HPV vaccine for their daughters and sons. Methods: We recruited 1660 participants aged 20 years or older in March 2018 via a webpage and provided them with a 10-item questionnaire related to the following aspects: awareness regarding HPV infection and vaccination, willingness for immunization, and actions for prevention. We randomly stratified participants based on sex and age with or without a brief educational intervention involving scientific information presented in an easy-to-read format. Results: Only 484 (29.2\%) of the respondents were aware of the benefits of HPV vaccination. Although only 352 (21.2\%) of the respondents displayed a willingness for immunization of their daughters, there were 40 (4.8\%) more respondents in the intervention group with this willingness (adjusted odds ratio [aOR] 1.32, 95\% CI 1.04-1.69). In a subanalysis, the willingness toward vaccination for daughters in men was significantly higher in the intervention group (aOR 1.46, 95\% CI 1.05-2.02). However, such a difference was not observed among women (aOR 1.20, 95\% CI 0.83-1.73). Conclusions: This study suggests that a brief web-based educational intervention increases the willingness of adults to consider the HPV vaccine for their children, especially among men. Thus, providing adequate information to men may be a useful strategy to improve the currently low rates of HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000049745 (UMIN-CTR); https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000049745 ",
doi="10.2196/28355",
url="https://www.jmir.org/2021/9/e28355",
url="http://www.ncbi.nlm.nih.gov/pubmed/34569941"
}


@Article{info:doi/10.2196/30451,
author="Tomaszewski, Tre
and Morales, Alex
and Lourentzou, Ismini
and Caskey, Rachel
and Liu, Bing
and Schwartz, Alan
and Chin, Jessie",
title="Identifying False Human Papillomavirus (HPV) Vaccine Information and Corresponding Risk Perceptions From Twitter: Advanced Predictive Models",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="9",
volume="23",
number="9",
pages="e30451",
keywords="misinformation",
keywords="disinformation",
keywords="social media",
keywords="HPV",
keywords="human papillomavirus vaccination",
keywords="vaccination",
keywords="causality mining",
keywords="cause",
keywords="effect",
keywords="risk perceptions",
keywords="vaccine",
keywords="perception",
keywords="risk",
keywords="Twitter",
keywords="machine learning",
keywords="natural language processing",
keywords="cervical cancer",
abstract="Background: The vaccination uptake rates of the human papillomavirus (HPV) vaccine remain low despite the fact that the effectiveness of HPV vaccines has been established for more than a decade. Vaccine hesitancy is in part due to false information about HPV vaccines on social media. Combating false HPV vaccine information is a reasonable step to addressing vaccine hesitancy. Objective: Given the substantial harm of false HPV vaccine information, there is an urgent need to identify false social media messages before it goes viral. The goal of the study is to develop a systematic and generalizable approach to identifying false HPV vaccine information on social media. Methods: This study used machine learning and natural language processing to develop a series of classification models and causality mining methods to identify and examine true and false HPV vaccine--related information on Twitter. Results: We found that the convolutional neural network model outperformed all other models in identifying tweets containing false HPV vaccine--related information (F score=91.95). We also developed completely unsupervised causality mining models to identify HPV vaccine candidate effects for capturing risk perceptions of HPV vaccines. Furthermore, we found that false information contained mostly loss-framed messages focusing on the potential risk of vaccines covering a variety of topics using more diverse vocabulary, while true information contained both gain- and loss-framed messages focusing on the effectiveness of vaccines covering fewer topics using relatively limited vocabulary. Conclusions: Our research demonstrated the feasibility and effectiveness of using predictive models to identify false HPV vaccine information and its risk perceptions on social media. ",
doi="10.2196/30451",
url="https://www.jmir.org/2021/9/e30451",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499043"
}


@Article{info:doi/10.2196/26478,
author="Du, Jingcheng
and Preston, Sharice
and Sun, Hanxiao
and Shegog, Ross
and Cunningham, Rachel
and Boom, Julie
and Savas, Lara
and Amith, Muhammad
and Tao, Cui",
title="Using Machine Learning--Based Approaches for the Detection and Classification of Human Papillomavirus Vaccine Misinformation: Infodemiology Study of Reddit Discussions",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="5",
volume="23",
number="8",
pages="e26478",
keywords="HPV vaccine",
keywords="social media",
keywords="misinformation",
keywords="infodemiology",
keywords="infoveillance",
keywords="deep learning",
keywords="Reddit",
keywords="machine learning",
abstract="Background: The rapid growth of social media as an information channel has made it possible to quickly spread inaccurate or false vaccine information, thus creating obstacles for vaccine promotion. Objective: The aim of this study is to develop and evaluate an intelligent automated protocol for identifying and classifying human papillomavirus (HPV) vaccine misinformation on social media using machine learning (ML)--based methods. Methods: Reddit posts (from 2007 to 2017, N=28,121) that contained keywords related to HPV vaccination were compiled. A random subset (2200/28,121, 7.82\%) was manually labeled for misinformation and served as the gold standard corpus for evaluation. A total of 5 ML-based algorithms, including a support vector machine, logistic regression, extremely randomized trees, a convolutional neural network, and a recurrent neural network designed to identify vaccine misinformation, were evaluated for identification performance. Topic modeling was applied to identify the major categories associated with HPV vaccine misinformation. Results: A convolutional neural network model achieved the highest area under the receiver operating characteristic curve of 0.7943. Of the 28,121 Reddit posts, 7207 (25.63\%) were classified as vaccine misinformation, with discussions about general safety issues identified as the leading type of misinformed posts (2666/7207, 36.99\%). Conclusions: ML-based approaches are effective in the identification and classification of HPV vaccine misinformation on Reddit and may be generalizable to other social media platforms. ML-based methods may provide the capacity and utility to meet the challenge involved in intelligent automated monitoring and classification of public health misinformation on social media platforms. The timely identification of vaccine misinformation on the internet is the first step in misinformation correction and vaccine promotion. ",
doi="10.2196/26478",
url="https://www.jmir.org/2021/8/e26478",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383667"
}


@Article{info:doi/10.2196/24564,
author="Wawrzuta, Dominik
and Jaworski, Mariusz
and Gotlib, Joanna
and Panczyk, Mariusz",
title="Characteristics of Antivaccine Messages on Social Media: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="4",
volume="23",
number="6",
pages="e24564",
keywords="vaccination",
keywords="social media",
keywords="antivaccination movement",
keywords="vaccination refusal",
keywords="health communication",
keywords="public health",
keywords="vaccines",
abstract="Background: Supporters of the antivaccination movement can easily spread information that is not scientifically proven on social media. Therefore, learning more about their posts and activities is instrumental in effectively reacting and responding to the false information they publish, which is aimed at discouraging people from taking vaccines. Objective: This study aims to gather, assess, and synthesize evidence related to the current state of knowledge about antivaccine social media users' web-based activities. Methods: We systematically reviewed English-language papers from 3 databases (Scopus, Web of Science, and PubMed). A data extraction form was established, which included authors, year of publication, specific objectives, study design, comparison, and outcomes of significance. We performed an aggregative narrative synthesis of the included studies. Results: The search strategy retrieved 731 records in total. After screening for duplicates and eligibility, 18 articles were included in the qualitative synthesis. Although most of the authors analyzed text messages, some of them studied images or videos. In addition, although most of the studies examined vaccines in general, 5 focused specifically on human papillomavirus vaccines, 2 on measles vaccines, and 1 on influenza vaccines. The synthesized studies dealt with the popularity of provaccination and antivaccination content, the style and manner in which messages about vaccines were formulated for the users, a range of topics concerning vaccines (harmful action, limited freedom of choice, and conspiracy theories), and the role and activity of bots in the dissemination of these messages in social media. Conclusions: Proponents of the antivaccine movement use a limited number of arguments in their messages; therefore, it is possible to prepare publications clarifying doubts and debunking the most common lies. Public health authorities should continuously monitor social media to quickly find new antivaccine arguments and then create information campaigns for both health professionals and other users. ",
doi="10.2196/24564",
url="https://www.jmir.org/2021/6/e24564",
url="http://www.ncbi.nlm.nih.gov/pubmed/34085943"
}


@Article{info:doi/10.2196/21465,
author="Wang, Zixin
and Lau, F. Joseph T.
and Ip, Mary Tsun Kwan
and Yu, Yebo
and Fong, Francois
and Fang, Yuan
and Mo, H. Phoenix K.",
title="Two Web-Based and Theory-Based Interventions With and Without Brief Motivational Interviewing in the Promotion of Human Papillomavirus Vaccination Among Chinese Men Who Have Sex With Men: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="2",
volume="23",
number="2",
pages="e21465",
keywords="HPV vaccination",
keywords="web-based health promotion",
keywords="randomized controlled trial",
keywords="men who have sex with men",
keywords="China",
keywords="mobile phone",
abstract="Background: Human papillomavirus (HPV) vaccination is effective in the prevention of vaccine-type genital warts and cancers among men who have sex with men (MSM). Objective: The primary objective of this randomized controlled trial (RCT) is to evaluate the efficacies of 2 web- and theory--based interventions with and without brief motivational interviewing (MI) over the phone to increase the completion of HPV vaccination among unvaccinated participants within a 24-month follow-up period compared with the control group. Methods: A 3-arm parallel-group RCT was conducted between July 2017 and December 2019. Five telephone surveys were conducted at baseline and at 3, 6, 9, and 24 months by blinded interviewers. Participants were Hong Kong Chinese--speaking MSM aged between 18 and 45 years with regular internet access who were recruited from outreaching at venues, web-based recruitment, and peer referral. Those who had ever received HPV vaccination were excluded. A total of 624 participants were randomized into either the online tutorial (OT) only group (n=208), the OT plus MI group (OT-MI; n=208), or the control group (n=208). In total, 459 (459/624, 73.6\%) completed the follow-up evaluation at 24 months. Participants in the OT group received a fully automated OT developed based on the health belief model. On top of the same OT, the OT-MI group received brief MI over the phone. Reminders were sent to the participants of the OT and OT-MI groups after 1, 2, 4, 6, and 8 months. Participants in the control group received web-based health communication messages unrelated to HPV or HPV vaccination. The research team validated the self-reported HPV vaccination uptake. Intention-to-treat analysis was used for outcome analyses. Logistic regression models and multivariable linear regression models were used to test the between-group differences in primary and secondary outcomes. Baron and Kenny's methods were used to test the mediation hypothesis. Results: The participants in the OT-MI group reported a significantly higher validated completion of HPV vaccination at 24 months than the control group (36/208, 17.3\% vs 15/208, 7.2\%; P=.006). However, the difference in HPV vaccination completion between the OT and the control groups (24/208, 11.5\% vs 15/208, 7.2\%; P=.17), or between OT-MI and OT groups (P=.13), was not statistically significant. The association between randomization status (OT-MI group vs control group) and HPV vaccination completion became statistically nonsignificant after controlling for changes in the perceived susceptibility to HPV (24 months vs baseline), whereas perceived susceptibility remained strongly associated with HPV vaccination uptake in the model (P<.001). Changes in perceived susceptibility fully mediated the intervention effect. Conclusions: Theory-based OT with brief MI over the phone was effective in increasing HPV vaccination completion among Chinese MSM. Perceived susceptibility is an active theoretical component that causes behavioral changes. Trial Registration: ClinicalTrials.gov NCT03286907; https://clinicaltrials.gov/ct2/show/NCT03286907 ",
doi="10.2196/21465",
url="https://www.jmir.org/2021/2/e21465",
url="http://www.ncbi.nlm.nih.gov/pubmed/33528372"
}


@Article{info:doi/10.2196/21303,
author="Darville, Gabrielle
and Burns, Jade
and Chavanduka, Tanaka
and Anderson-Lewis, Charkarra",
title="Utilizing Theories and Evaluation in Digital Gaming Interventions to Increase Human Papillomavirus Vaccination Among Young Males: Qualitative Study",
journal="JMIR Serious Games",
year="2021",
month="Jan",
day="22",
volume="9",
number="1",
pages="e21303",
keywords="digital games",
keywords="behavior change",
keywords="theory",
keywords="evaluation",
keywords="game design",
keywords="health care providers",
abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. HPV attributes to most cancers including anal, oral, cervical, and penile. Despite infection rates in the United States, recommendations and communication campaigns have traditionally focused on females. Because of this, males lack knowledge about reasons for vaccination, the benefits of being vaccinated, and their HPV risk, overall. Gaming as a health education strategy can be beneficial as mechanism that can promote behavior change for this key demographic because of the popularity of gaming. Objective: We sought to explore the relationship between gamification and HPV vaccine uptake. Methods: Interviews were conducted with experts (n=22) in the fields of cancer prevention, sexual and reproductive health, public health, game design, technology, and health communication on how a game should be developed to increase HPV vaccination rates among males. Results: Overwhelmingly, theoretical models such as the health belief model were identified with key constructs such as self-efficacy and risk perception. Experts also suggested using intervention mapping and logic models as planning tools for health promotion interventions utilizing a digital game as a medium. In game and out of game measures were discussed as assessments for quality and impact by our expert panel. Conclusions: This study shows that interventions should focus on whether greater utilization of serious games, and the incorporation of theory and standardized methods, can encourage young men to get vaccinated and to complete the series of HPV vaccinations. ",
doi="10.2196/21303",
url="http://games.jmir.org/2021/1/e21303/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33480856"
}


@Article{info:doi/10.2196/21451,
author="Massey, M. Philip
and Kearney, D. Matthew
and Hauer, K. Michael
and Selvan, Preethi
and Koku, Emmanuel
and Leader, E. Amy",
title="Dimensions of Misinformation About the HPV Vaccine on Instagram: Content and Network Analysis of Social Media Characteristics",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="3",
volume="22",
number="12",
pages="e21451",
keywords="social media",
keywords="cancer",
keywords="vaccination",
keywords="health communication",
keywords="public health",
keywords="HPV, human papillomavirus",
abstract="Background: The human papillomavirus (HPV) vaccine is a major advancement in cancer prevention and this primary prevention tool has the potential to reduce and eliminate HPV-associated cancers; however, the safety and efficacy of vaccines in general and the HPV vaccine specifically have come under attack, particularly through the spread of misinformation on social media. The popular social media platform Instagram represents a significant source of exposure to health (mis)information; 1 in 3 US adults use Instagram. Objective: The objective of this analysis was to characterize pro- and anti-HPV vaccine networks on Instagram, and to describe misinformation within the anti-HPV vaccine network. Methods: From April 2018 to December 2018, we collected publicly available English-language Instagram posts containing hashtags \#HPV, \#HPVVaccine, or \#Gardasil using Netlytic software (n=16,607). We randomly selected 10\% of the sample and content analyzed relevant posts (n=580) for text, image, and social media features as well as holistic attributes (eg, sentiments, personal stories). Among antivaccine posts, we organized elements of misinformation within four broad dimensions: 1) misinformation theoretical domains, 2) vaccine debate topics, 3) evidence base, and 4) health beliefs. We conducted univariate, bivariate, and network analyses on the subsample of posts to quantify the role and position of individual posts in the network. Results: Compared to provaccine posts (324/580, 55.9\%), antivaccine posts (256/580, 44.1\%) were more likely to originate from individuals (64.1\% antivaccine vs 25.0\% provaccine; P<.001) and include personal narratives (37.1\% vs 25.6\%; P=.003). In the antivaccine network, core misinformation characteristics included mentioning \#Gardasil, purporting to reveal a lie (ie, concealment), conspiracy theories, unsubstantiated claims, and risk of vaccine injury. Information/resource posts clustered around misinformation domains including falsification, nanopublications, and vaccine-preventable disease, whereas personal narrative posts clustered around different domains of misinformation, including concealment, injury, and conspiracy theories. The most liked post (6634 likes) in our full subsample was a positive personal narrative post, created by a non-health individual; the most liked post (5604 likes) in our antivaccine subsample was an informational post created by a health individual. Conclusions: Identifying characteristics of misinformation related to HPV vaccine on social media will inform targeted interventions (eg, network opinion leaders) and help sow corrective information and stories tailored to different falsehoods. ",
doi="10.2196/21451",
url="https://www.jmir.org/2020/12/e21451",
url="http://www.ncbi.nlm.nih.gov/pubmed/33270038"
}


@Article{info:doi/10.2196/16883,
author="Cates, R. Joan
and Fuemmeler, F. Bernard
and Stockton, L. Laurie
and Diehl, J. Sandra
and Crandell, L. Jamie
and Coyne-Beasley, Tamera",
title="Evaluation of a Serious Video Game to Facilitate Conversations About Human Papillomavirus Vaccination for Preteens: Pilot Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2020",
month="Dec",
day="3",
volume="8",
number="4",
pages="e16883",
keywords="video games",
keywords="papillomavirus vaccines",
keywords="adolescent health",
abstract="Background: In the United States, the most common sexually transmitted infection, human papillomavirus (HPV), causes genital warts and is associated with an estimated 33,700 newly diagnosed cancer cases annually. HPV vaccination, especially for preteens aged 11 to 12 years, is effective in preventing the acquisition of HPV and HPV-associated cancers. However, as of 2018, completion of the 2- or 3-dose HPV vaccination series increased only from 48.6\% to 51.1\% in teens aged 13 to 17 years, and this increase was observed only in boys. By comparison, 88.7\% of teens had more than one dose of the recommended vaccine against tetanus, diphtheria, and acellular pertussis (Tdap), and 85.1\% of teens had more than one dose of meningococcal vaccine. Immunizations for Tdap, meningococcal disease, and HPV can occur at the same clinical visit but often do not. Objective: Vaccination against HPV is recommended for routine use in those aged 11 to 12 years in the United States, yet it is underutilized. We aimed to develop an educational video game to engage preteens in the decision to vaccinate. Methods: Land of Secret Gardens is a metaphor for protecting seedlings (body) with a potion (vaccine). We screened 131 dyads of parents and preteens from 18 primary practices in North Carolina who had not initiated HPV vaccination. We measured vaccination intentions, story immersion, and game play and documented HPV vaccination rates. A total of 55 dyads were enrolled, and we randomly assigned 28 (21 completed) to play the game and 27 (26 completed) to the comparison group. Results: In total, 18 preteens reported playing the game. The vaccination self-efficacy score was higher in the comparison group than the intervention group (1.65 vs 1.45; P=.05). The overall mean decisional balance score trended toward greater support of vaccination, although differences between the groups were not significant.. Vaccine initiation and completion rates were higher in the intervention group (22\% vs 15\%; P=.31) than in the comparison group (9\% vs 2\%; P=.10), although the difference was not significant. Conclusions: Video games help preteens in the decision to pursue HPV vaccination. A serious video game on HPV vaccination is acceptable to parents and preteens and can be played as intended. Gamification is effective in increasing preteen interest in HPV vaccination, as game features support decision making for HPV vaccination. Trial Registration: ClinicalTrials.gov NCT04627298; https://www.clinicaltrials.gov/ct2/show/NCT04627298 ",
doi="10.2196/16883",
url="https://games.jmir.org/2020/4/e16883",
url="http://www.ncbi.nlm.nih.gov/pubmed/33270028"
}


@Article{info:doi/10.2196/22878,
author="Fontenot, B. Holly
and White, Patrick Bradley
and Rosenberger, G. Joshua
and Lacasse, Hailee
and Rutirasiri, Chokdee
and Mayer, H. Kenneth
and Zimet, Gregory",
title="Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="4",
volume="22",
number="11",
pages="e22878",
keywords="human papillomavirus",
keywords="men who have sex with men",
keywords="vaccination",
keywords="mobile health tool",
keywords="mHealth",
abstract="Background: Mobile app-based interventions have been identified as potential facilitators for vaccination among young men who have sex with men (MSM). Objective: This pilot study aimed to test the feasibility of a theoretically informed mobile health (mHealth) tool designed to reduce health disparities and facilitate human papillomavirus (HPV) vaccination among a sample of young MSM. Methods: The development of the mHealth tool was guided by previous research, implementation intention theory, and design thinking. We recruited MSM aged 18-26 years through a popular online dating app and linked participants to our mHealth tool, which provided HPV vaccine information and fostered access to care. Results: A total of 42 young MSM participated in this pilot study in Boston, Massachusetts. Participants reported variable HPV knowledge (ie, high knowledge of HPV risk factors and low knowledge of HPV-related cancer risks for men) and positive vaccine beliefs and attitudes. Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23\% (8/35) utilized the mHealth tool to obtain HPV vaccination. Participants primarily utilized the tool's (1) educational components and (2) capabilities facilitating concrete vaccine action plans. Conclusions: We recruited an underserved at-risk population of youth via an online dating app for our mHealth intervention that resulted in in-person health care delivery. This study was limited by enrollment challenges, including low willingness to download the mHealth tool to mobile devices. ",
doi="10.2196/22878",
url="https://www.jmir.org/2020/11/e22878",
url="http://www.ncbi.nlm.nih.gov/pubmed/33146621"
}


@Article{info:doi/10.2196/19503,
author="Teitelman, M. Anne
and Gregory, F. Emily
and Jayasinghe, Joshua
and Wermers, Zara
and Koo, H. Ja
and Morone, F. Jennifer
and Leri, C. Damien
and Davis, Annet
and Feemster, A. Kristen",
title="Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study",
journal="JMIR Nursing",
year="2020",
month="Oct",
day="29",
volume="3",
number="1",
pages="e19503",
keywords="cervical cancer",
keywords="prevention",
keywords="mobile health",
keywords="parents",
keywords="adolescent health",
keywords="vaccine",
keywords="human papillomavirus",
abstract="Background: More than 90\% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. Objective: The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. Methods: Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. Results: Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75\% (15/20) of adolescents and 88\% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88\% (30/34) of parents and 75\% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82\% (28/34) of parents and 85\% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95\% CI --2.15 to 0.15). Conclusions: mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines. ",
doi="10.2196/19503",
url="https://nursing.jmir.org/2020/1/e19503/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345789"
}


@Article{info:doi/10.2196/19018,
author="Ferrand, John
and Hockensmith, Ryli
and Houghton, Fagen Rebecca
and Walsh-Buhi, R. Eric",
title="Evaluating Smart Assistant Responses for Accuracy and Misinformation Regarding Human Papillomavirus Vaccination: Content Analysis Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="3",
volume="22",
number="8",
pages="e19018",
keywords="digital health",
keywords="human papillomavirus",
keywords="smart assistants",
keywords="chatbots",
keywords="conversational agents",
keywords="misinformation",
keywords="infodemiology",
keywords="vaccination",
abstract="Background: Almost half (46\%) of Americans have used a smart assistant of some kind (eg, Apple Siri), and 25\% have used a stand-alone smart assistant (eg, Amazon Echo). This positions smart assistants as potentially useful modalities for retrieving health-related information; however, the accuracy of smart assistant responses lacks rigorous evaluation. Objective: This study aimed to evaluate the levels of accuracy, misinformation, and sentiment in smart assistant responses to human papillomavirus (HPV) vaccination--related questions. Methods: We systematically examined responses to questions about the HPV vaccine from the following four most popular smart assistants: Apple Siri, Google Assistant, Amazon Alexa, and Microsoft Cortana. One team member posed 10 questions to each smart assistant and recorded all queries and responses. Two raters independently coded all responses ($\kappa$=0.85). We then assessed differences among the smart assistants in terms of response accuracy, presence of misinformation, and sentiment regarding the HPV vaccine. Results: A total of 103 responses were obtained from the 10 questions posed across the smart assistants. Google Assistant data were excluded owing to nonresponse. Over half (n=63, 61\%) of the responses of the remaining three smart assistants were accurate. We found statistically significant differences across the smart assistants (N=103, $\chi$22=7.807, P=.02), with Cortana yielding the greatest proportion of misinformation. Siri yielded the greatest proportion of accurate responses (n=26, 72\%), whereas Cortana yielded the lowest proportion of accurate responses (n=33, 54\%). Most response sentiments across smart assistants were positive (n=65, 64\%) or neutral (n=18, 18\%), but Cortana's responses yielded the largest proportion of negative sentiment (n=7, 12\%). Conclusions: Smart assistants appear to be average-quality sources for HPV vaccination information, with Alexa responding most reliably. Cortana returned the largest proportion of inaccurate responses, the most misinformation, and the greatest proportion of results with negative sentiments. More collaboration between technology companies and public health entities is necessary to improve the retrieval of accurate health information via smart assistants. ",
doi="10.2196/19018",
url="https://www.jmir.org/2020/8/e19018",
url="http://www.ncbi.nlm.nih.gov/pubmed/32744508"
}


@Article{info:doi/10.2196/14822,
author="Pot, Mirjam
and Paulussen, GWM Theo
and Ruiter, AC Robert
and Mollema, Liesbeth
and Hofstra, Miranda
and Van Keulen, M. Hilde",
title="Dose-Response Relationship of a Web-Based Tailored Intervention Promoting Human Papillomavirus Vaccination: Process Evaluation of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="17",
volume="22",
number="7",
pages="e14822",
keywords="HPV vaccination",
keywords="web-based tailored intervention",
keywords="process evaluation",
keywords="intervention use",
keywords="dose-response relationship",
keywords="randomized controlled trial",
keywords="informed decision making",
abstract="Background: In the Netherlands, human papillomavirus (HPV) vaccination uptake remains low. To improve informed decision making (IDM) and HPV vaccination acceptability, we systematically developed an interactive, web-based tailored intervention to which mothers of Dutch girls were invited to participate. Objective: The aim of this study was to provide insight into the intervention's working mechanisms by evaluating (1) program use, (2) program acceptability, and (3) the relationship of program use with program acceptability and intervention effects (ie, dose-response relationship). Methods: Only mothers from the intervention arm of a randomized controlled trial that assessed the effectiveness of the web-based, tailored intervention were included in this study. They were invited to visit the website of the web-based intervention between baseline (January 2015, just before access to the intervention) and follow up (March 2015, prior to the first HPV vaccination). Indicators for program use were time of website use (ie, duration of intervention exposure) and completeness (ie, proportion of all available web pages visited). HPV vaccination uptake registered by Praeventis was used as the primary outcome. Secondary outcomes were IDM, decisional conflict, and social-psychological determinants of HPV vaccination uptake. Results: Among the 3995 invited mothers, 2509 (62.80\%) logged on to the website, 2239 of whom (89.24\%) visited at least one page of the intervention components. On average, mothers spent 21.39 minutes (SD 12.41) on the website and completed 50.04\% (SD 26.18\%) of the website components. Participants rated the website 7.64 (SD 1.39) on a 10-point scale. Program acceptability was significantly associated with completeness ($\beta$=4.36, P<.001), but not with time of website use ($\beta$=--.07, P=.77). Intention-to-treat analysis (N=3995) showed a significant positive effect of completeness on all outcome measures (all P<.003; Bonferroni-corrected $\alpha$=.05/15 factors), including on HPV vaccination uptake. Time of website use had a significant positive effect on all outcomes (all P<.003), except for uptake (P=.20), risk perception when not vaccinated (P=.14), subjective norms (P=.03), and habit (P=.01). Conclusions: Program use and acceptability of the intervention were adequate. Completeness was positively associated with acceptability. Furthermore, positive effects (ie, dose-response effects) were found for completeness and time of website use on the mothers' IDM, decisional conflict, and almost all of the social-psychological determinants of HPV vaccination acceptability. In addition, the extent to which mothers completed the intervention had a positive impact on their daughters' vaccination uptake. This indicates that the web-based, tailored intervention fits well with the mothers' needs, and that completeness of use is essential for improving HPV vaccination uptake, acceptability, and IDM. Program use should therefore be promoted. Trial Registration: Netherlands Trial Register NTR4795; https://www.trialregister.nl/trial/4795 ",
doi="10.2196/14822",
url="https://www.jmir.org/2020/7/e14822",
url="http://www.ncbi.nlm.nih.gov/pubmed/32520718"
}


@Article{info:doi/10.2196/17446,
author="Liu, Zhike
and Zhang, Liang
and Yang, Yu
and Meng, Ruogu
and Fang, Ting
and Dong, Ying
and Li, Ning
and Xu, Guozhang
and Zhan, Siyan",
title="Active Surveillance of Adverse Events Following Human Papillomavirus Vaccination: Feasibility Pilot Study Based on the Regional Health Care Information Platform in the City of Ningbo, China",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="1",
volume="22",
number="6",
pages="e17446",
keywords="safety",
keywords="HPV",
keywords="human papillomavirus",
keywords="vaccine",
keywords="active surveillance",
abstract="Background: Comprehensive safety data for vaccines from post-licensure surveillance, especially active surveillance, could guide administrations and individuals to make reasonable decisions on vaccination. Therefore, we designed a pilot study to assess the capability of a regional health care information platform to actively monitor the safety of a newly licensed vaccine. Objective: This study aimed to conduct active surveillance of human papillomavirus (HPV) vaccine safety based on this information platform. Methods: In 2017, one of China's most mature information platforms with superior data linkage was selected. A structured questionnaire and open-ended interview guidelines were developed to investigate the feasibility of active surveillance following HPV vaccination using the regional health care information platform in Ningbo. The questionnaire was sent to participants via email, and a face-to-face interview was conducted to confirm details or resolve discrepancies. Results: Five databases that could be considered essential to active surveillance of vaccine safety were integrated into the platform starting in 2015. Except for residents' health records, which had a coverage rate of 87\%, the data sources covered more than 95\% of the records that were documented in Ningbo. All the data could be inherently linked using the national identity card. There were 19,328 women who received the HPV vaccine, and 37,988 doses were administered in 2017 and 2018. Women aged 30-40 years accounted for the largest proportion. Quadrivalent vaccination accounted for 73.1\% of total vaccination, a much higher proportion than that of bivalent vaccination. Of the first doses, 60 (60/19,328, 0.31\%) occurred outside Ningbo. There were no missing data for vaccination-relevant variables, such as identity card, vaccine name, vaccination doses, vaccination date, and manufacturer. ICD-10 coding could be used to identify 9,180 cases using a predefined list of the outcomes of interest, and 1.88\% of these cases were missing the identity card. During the 90 days following HPV vaccination, 4 incident cases were found through the linked vaccination history and electronic medical records. The combined incident rate of rheumatoid arthritis, optic neuritis, and Henoch-Schonlein purpura was 8.84/100,000 doses of bivalent HPV, and the incidence rate of rheumatoid arthritis was 3.75/100,000 doses of quadrivalent HPV. Conclusions: This study presents an available approach to initiate an active surveillance system for adverse events following HPV vaccination, based on a regional health care information platform in China. An extended observation period or the inclusion of additional functional sites is warranted to conduct future hypothesis-generating and hypothesis-confirming studies for vaccine safety concerns. ",
doi="10.2196/17446",
url="https://www.jmir.org/2020/6/e17446",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234696"
}


@Article{info:doi/10.2196/14652,
author="Sanchez Antelo, Victoria
and Kohler, E. Racquel
and Curotto, Mariana
and Viswanath, ``Vish'' Kasisomayajula
and Paolino, Melisa
and Arrossi, Silvina",
title="Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study",
journal="JMIR Form Res",
year="2020",
month="Mar",
day="6",
volume="4",
number="3",
pages="e14652",
keywords="text messaging",
keywords="cell phone use",
keywords="telemedicine",
keywords="human papillomavirus DNA tests",
keywords="triage",
keywords="health behavior",
keywords="Argentina",
abstract="Background: SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)--positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. Objective: This study aimed to understand the cultural and contextual elements, women's beliefs, and perceptions regarding the use of SMS by the health care system and women's preferences about the message content. Methods: We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. Results: A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word ``HPV'' was also a key component of the desired SMS content; therefore, the final message included the term ``self-collection'' without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. Conclusions: The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage. ",
doi="10.2196/14652",
url="https://formative.jmir.org/2020/3/e14652",
url="http://www.ncbi.nlm.nih.gov/pubmed/32032940"
}


@Article{info:doi/10.2196/16294,
author="Reiter, L. Paul
and Gower, L. Amy
and Kiss, E. Dale
and Malone, A. Molly
and Katz, L. Mira
and Bauermeister, A. Jose
and Shoben, B. Abigail
and Paskett, D. Electra
and McRee, Annie-Laurie",
title="A Web-Based Human Papillomavirus Vaccination Intervention for Young Gay, Bisexual, and Other Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="24",
volume="9",
number="2",
pages="e16294",
keywords="human papillomavirus",
keywords="human papillomavirus vaccination",
keywords="gay or bisexual",
keywords="men who have sex with men",
keywords="intervention",
keywords="young adult",
abstract="Background: Gay, bisexual, and other men who have sex with men experience several disparities related to human papillomavirus (HPV) infection, including high incidence rates of anal cancer. Although the HPV vaccine is currently recommended for young adults, HPV vaccine coverage is modest among young gay, bisexual, and other men who have sex with men (YGBMSM). Objective: We describe the design and methods for a randomized controlled trial (RCT) to rigorously evaluate Outsmart HPV, a population-targeted, individually tailored, Web-based HPV vaccination intervention for YGBMSM. The RCT is designed to determine the efficacy of the intervention, the mechanism by which the intervention has an effect (ie, mediation), and whether efficacy varies by participant characteristics (ie, moderation). Methods: Outsmart HPV was previously developed and pilot-tested. This study is a 3-arm prospective RCT that will enroll a projected 1995 YGBMSM who are aged 18 to 25 years, live in the United States, and have not received any doses of the HPV vaccine. Participants will be recruited by means of paid advertisements on social media sites and randomized to receive (1) standard information on the Web about HPV vaccine (control group), (2) Outsmart HPV content on the Web with monthly unidirectional vaccination reminders sent via text messages, or (3) Outsmart HPV content on the Web with monthly interactive vaccination reminders sent via text messages. Participants will complete Web-based surveys at 4 time points during the study: baseline, immediately after engaging with Web-based content, 3 months after randomization, and 9 months after randomization. Primary outcomes will include both HPV vaccine initiation (ie, receipt of 1 or more doses of the HPV vaccine) and completion (receipt of all 3 doses recommended for this age range). We will examine constructs from the intervention's theoretical framework as potential mediators and demographic and health-related characteristics as potential moderators of intervention effects. Results: The institutional review board at The Ohio State University has approved the study. Materials have been developed and finalized for all study groups. Recruitment for the RCT began in fall 2019. Conclusions: If shown to be efficacious, Outsmart HPV has the potential to fill an important gap by promoting HPV vaccination among a population at increased risk of HPV infection and HPV-related disease. Trial Registration: ClinicalTrials.gov NCT04032106; http://clinicaltrials.gov/show/NCT04032106 International Registered Report Identifier (IRRID): PRR1-10.2196/16294 ",
doi="10.2196/16294",
url="http://www.researchprotocols.org/2020/2/e16294/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130192"
}


@Article{info:doi/10.2196/14111,
author="Kim, Minjin
and Lee, Haeok
and Allison, Jeroan",
title="Challenges and Lessons Learned From a Mobile Health, Web-Based Human Papillomavirus Intervention for Female Korean American College Students: Feasibility Experimental Study",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="29",
volume="4",
number="1",
pages="e14111",
keywords="mHealth",
keywords="Web-based intervention",
keywords="fraud",
keywords="experimental design",
abstract="Background: Mobile health (mHealth) and Web-based research methods are becoming more commonplace for researchers. However, there is a lack of mHealth and Web-based human papillomavirus (HPV) prevention experimental studies that discuss potential issues that may arise. Objective: This study aimed to assess the feasibility of research procedures and discuss the challenges and lessons learned from an mHealth and Web-based HPV prevention experimental study targeting female Korean American college students in the United States. Methods: A pilot randomized controlled trial (RCT) was conducted in an mHealth and Web-based platform with 104 female Korean American college students aged 18-26 years between September 2016 and December 2016. Participants were randomized to either the experimental group (a storytelling video intervention) or the comparison group (a nonnarrative, information-based intervention). Outcomes included the feasibility of research procedures (recruitment, eligibility, randomization, and retention). Results: From September 2016 to October 2016, we recorded 225 entries in our initial eligibility survey. The eligibility rate was 54.2\% (122/225). This study demonstrated a high recruitment rate (95.6\%, 111/122) and retention rate (83.7\%, 87/104) at the 2-month follow-up. Conclusions: Findings from this study demonstrated sufficient feasibility in terms of research procedures to justify a full-scale RCT. Given the increased possibility of invalid or misrepresentative entries in mHealth and Web-based studies, strategies for detection and prevention are critical. Trial Registration: ISRCTN Registry ISRCTN12175285;?http://www.isrctn.com/ISRCTN12175285 ",
doi="10.2196/14111",
url="http://formative.jmir.org/2020/1/e14111/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012036"
}


@Article{info:doi/10.2196/16487,
author="Oliveira, R. Carlos
and Avni-Singer, Lital
and Badaro, Geovanna
and Sullivan, L. Erin
and Sheth, S. Sangini
and Shapiro, D. Eugene
and Niccolai, M. Linda",
title="Feasibility and Accuracy of a Computer-Assisted Self-Interviewing Instrument to Ascertain Prior Immunization With Human Papillomavirus Vaccine by Self-Report: Cross-Sectional Analysis",
journal="JMIR Med Inform",
year="2020",
month="Jan",
day="22",
volume="8",
number="1",
pages="e16487",
keywords="human papillomavirus vaccine",
keywords="self-report",
keywords="accuracy",
keywords="computer-assisted self-interviewing",
abstract="Background: Ascertaining history of prior immunization with human papillomavirus (HPV) vaccine can be challenging and resource-intensive. Computer-assisted self-interviewing instruments have the potential to address some of the challenges of self-reporting, and may also reduce the time, costs, and efforts associated with ascertaining immunization status. Objective: This study assesses both the feasibility and the accuracy of a computer-assisted self-interviewing instrument to ascertain a patient's history of immunization with the HPV vaccine. Methods: We developed both a survey and a Web-based data collection system using computer-assisted self-interviewing to ascertain self-reported HPV vaccine immunization history. We implemented the instrument in a sample of adult women enrolled in an ongoing study of the HPV vaccine. Vaccine records from prior sources of care were reviewed to verify reported immunization history. Results: Among the 312 participants who provided HPV vaccine immunization history by self-report, almost all (99\%) were able to do so using the computer-assisted self-interviewing instrument. The median survey completion time was 10 minutes (IQR 7-17). The accuracy of self-report was 84\%, sensitivity was 89\%, specificity was 80\%, and the negative predictive value was 92\%. Conclusions: We found that it is feasible to collect a history of immunization with the HPV vaccine using a computer-assisted self-interviewing instrument. This approach is likely to be acceptable to adult women and is reasonably accurate in a clinical research setting. ",
doi="10.2196/16487",
url="http://medinform.jmir.org/2020/1/e16487/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012073"
}


@Article{info:doi/10.2196/13256,
author="Lee, Yun Hee
and Lee, Hwa Mi
and Sharratt, Monica
and Lee, Sohye
and Blaes, Anne",
title="Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jun",
day="6",
volume="7",
number="6",
pages="e13256",
keywords="uterine cervical cancer",
keywords="papanicolaou test",
keywords="papillomavirus infections",
keywords="papillomavirus vaccines",
keywords="text messaging",
keywords="Asian American",
keywords="immigrants",
abstract="Background: Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. Objective: The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. Methods: Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke's thematic analysis was used to identify core themes. Results: Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). Conclusions: This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population's perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups. ",
doi="10.2196/13256",
url="https://mhealth.jmir.org/2019/6/e13256/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199340"
}


@Article{info:doi/10.2196/13373,
author="Abed Elhadi Shahbari, Nour
and Gesser-Edelsburg, Anat
and Mesch, S. Gustavo",
title="Case of Paradoxical Cultural Sensitivity: Mixed Method Study of Web-Based Health Informational Materials About the Human Papillomavirus Vaccine in Israel",
journal="J Med Internet Res",
year="2019",
month="May",
day="17",
volume="21",
number="5",
pages="e13373",
keywords="web-based health informational materials",
keywords="HPV vaccine",
keywords="Israel",
keywords="cultural sensitivity",
keywords="transparency",
keywords="sexuality",
keywords="quantitative analysis",
keywords="qualitative content analysis",
keywords="Hebrew and Arabic",
abstract="Background: Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine's safety and effectiveness and the sexual and moral concerns related to its use. Objective: The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials. Methods: The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO). Results: The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep). Conclusions: The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture. ",
doi="10.2196/13373",
url="http://www.jmir.org/2019/5/e13373/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31102371"
}


@Article{info:doi/10.2196/games.8540,
author="Ruiz-L{\'o}pez, Tom{\'a}s
and Sen, Sagar
and Jakobsen, Elisabeth
and Trop{\'e}, Ameli
and Castle, E. Philip
and Hansen, Terning Bo
and Nyg{\aa}rd, Mari",
title="FightHPV: Design and Evaluation of a Mobile Game to Raise Awareness About Human Papillomavirus and Nudge People to Take Action Against Cervical Cancer",
journal="JMIR Serious Games",
year="2019",
month="Apr",
day="08",
volume="7",
number="2",
pages="e8540",
keywords="papillomavirus vaccines",
keywords="educational technology",
keywords="uterine cervical neoplasms",
keywords="papillomavirus infections",
keywords="primary prevention",
keywords="secondary prevention",
keywords="early detection of cancer",
keywords="mobile applications",
keywords="health education",
keywords="learning",
abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, other anogenital cancer, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening; however, a lack of awareness and knowledge of HPV and these preventive strategies represents an important barrier to reducing the burden of the disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, and modern health communication strategies. Objective: This study aimed to describe the development of a mobile app called FightHPV, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods. Methods: The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of 6 participants aged between 40 and 50 years and a second focus group of 23 participants aged between 16 and 18 years. Gameplay data from the beta testing study were collected using Google Analytics (Google), whereas feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire. Results: FightHPV communicates concepts about HPV, associated diseases and their prevention by representing relationships among 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants who returned a questionnaire, all stated that FightHPV is an appealing educational tool, 69\% (18/26) reported that they liked the game, and 81\% (21/26) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game (P=.001). Conclusions: FightHPV was easy to access, use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate people to take action against HPV and cervical cancer. ",
doi="10.2196/games.8540",
url="https://games.jmir.org/2019/2/e8540/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30958271"
}


@Article{info:doi/10.2196/12480,
author="Lama, Yuki
and Hu, Dian
and Jamison, Amelia
and Quinn, Crouse Sandra
and Broniatowski, A. David",
title="Characterizing Trends in Human Papillomavirus Vaccine Discourse on Reddit (2007-2015): An Observational Study",
journal="JMIR Public Health Surveill",
year="2019",
month="Mar",
day="18",
volume="5",
number="1",
pages="e12480",
keywords="papillomavirus infections",
keywords="prevention \& control",
keywords="cancer prevention",
keywords="cervical cancer",
keywords="HPV",
keywords="vaccination",
keywords="papillomavirus vaccines",
keywords="immunology",
keywords="administration \& dosage",
keywords="social media",
keywords="health communication",
keywords="infodemiology",
abstract="Background: Despite the introduction of the human papillomavirus (HPV) vaccination as a preventive measure in 2006 for cervical and other cancers, uptake rates remain suboptimal, resulting in preventable cancer mortality. Social media, widely used for information seeking, can influence users' knowledge and attitudes regarding HPV vaccination. Little is known regarding attitudes related to HPV vaccination on Reddit (a popular news aggregation site and online community), particularly related to cancer risk and sexual activity. Examining HPV vaccine--related messages on Reddit may provide insight into how HPV discussions are characterized on forums online and influence decision making related to vaccination. Objective: We observed how the HPV vaccine is characterized on Reddit over time and by user gender. Specifically, this study aimed to determine (1) if Reddit messages are more related to cancer risks or sexual behavior and (2) what other HPV vaccine--related discussion topics appear on Reddit. Methods: We gathered all public Reddit comments from January 2007 to September 2015. We manually annotated 400 messages to generate keywords and identify salient themes. We then measured the similarity between each comment and lists of keywords associated with sexual behavior and cancer risk using Latent Semantic Analysis (LSA). Next, we used Latent Dirichlet Allocation (LDA) to characterize remaining topics within the Reddit data. Results: We analyzed 22,729 messages containing the strings hpv or human papillomavirus and vaccin. LSA findings show that HPV vaccine discussions are significantly more related to cancer compared with sexual behavior from 2008 to 2015 (P<.001). We did not find a significant difference between genders in discussions of cancer and sexual activity (P>.05). LDA analyses demonstrated that although topics related to cancer risk and sexual activity were both frequently discussed (16.1\% and 14.5\% of word tokens, respectively), the majority of online discussions featured other topics. The most frequently discussed topic was politics associated with the vaccine (17.2\%). Other topics included HPV disease and/or immunity (13.5\%), the HPV vaccine schedule (11.5\%), HPV vaccine side effects (9.7\%), hyperlinks to outside sources (9.1\%), and the risks and benefit of HPV vaccination (8.5\%). Conclusions: Reddit discourse on HPV vaccine encompasses a broad range of topics among men and women, with HPV political debates and cancer risk making up the plurality of the discussion. Our findings demonstrated that women and men both discussed HPV, highlighting that Reddit users do not perceive HPV as an issue that only pertains to women. Given the increasing use of social media as a source of health information, these results can inform the development of targeted online health communication strategies to promote HPV vaccination to young adult users of Reddit. Analyzing online discussions on Reddit can inform health communication efforts by identifying relevant, important HPV-related topics among online communities. ",
doi="10.2196/12480",
url="http://publichealth.jmir.org/2019/1/e12480/"
}


@Article{info:doi/10.2196/cancer.9114,
author="Rosen, L. Brittany
and Bishop, M. James
and McDonald, L. Skye
and Kahn, A. Jessica
and Kreps, L. Gary",
title="Quality of Web-Based Educational Interventions for Clinicians on Human Papillomavirus Vaccine: Content and Usability Assessment",
journal="JMIR Cancer",
year="2018",
month="Feb",
day="16",
volume="4",
number="1",
pages="e3",
keywords="papillomavirus vaccines",
keywords="internet",
keywords="program evaluation",
keywords="health personnel",
abstract="Background: Human papillomavirus (HPV) vaccination rates fall far short of Healthy People 2020 objectives. A leading reason is that clinicians do not recommend the vaccine consistently and strongly to girls and boys in the age group recommended for vaccination. Although Web-based HPV vaccine educational interventions for clinicians have been created to promote vaccination recommendations, rigorous evaluations of these interventions have not been conducted. Such evaluations are important to maximize the efficacy of educational interventions in promoting clinician recommendations for HPV vaccination. Objective: The objectives of our study were (1) to expand previous research by systematically identifying HPV vaccine Web-based educational interventions developed for clinicians and (2) to evaluate the quality of these Web-based educational interventions as defined by access, content, design, user evaluation, interactivity, and use of theory or models to create the interventions. Methods: Current HPV vaccine Web-based educational interventions were identified from general search engines (ie, Google), continuing medical education search engines, health department websites, and professional organization websites. Web-based educational interventions were included if they were created for clinicians (defined as individuals qualified to deliver health care services, such as physicians, clinical nurses, and school nurses, to patients aged 9 to 26 years), delivered information about the HPV vaccine and how to increase vaccination rates, and provided continuing education credits. The interventions' content and usability were analyzed using 6 key indicators: access, content, design, evaluation, interactivity, and use of theory or models. Results: A total of 21 interventions were identified, out of which 7 (33\%) were webinars, 7 (33\%) were videos or lectures, and 7 (33\%) were other (eg, text articles, website modules). Of the 21 interventions, 17 (81\%) identified the purpose of the intervention, 12 (57\%) provided the date that the information had been updated (7 of these were updated within the last 6 months), 14 (67\%) provided the participants with the opportunity to provide feedback on the intervention, and 5 (24\%) provided an interactive component. None of the educational interventions explicitly stated that a theory or model was used to develop the intervention. Conclusions: This analysis demonstrates that a substantial proportion of Web-based HPV vaccine educational interventions has not been developed using established health education and design principles. Interventions designed using these principles may increase strong and consistent HPV vaccination recommendations by clinicians. ",
doi="10.2196/cancer.9114",
url="http://cancer.jmir.org/2018/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29453187"
}


@Article{info:doi/10.2196/publichealth.8237,
author="Ueda, Nao
and Yokouchi, Ryoki
and Onoda, Taro
and Ogihara, Atsushi",
title="Characteristics of Articles About Human Papillomavirus Vaccination in Japanese Newspapers: Time-Series Analysis Study",
journal="JMIR Public Health Surveill",
year="2017",
month="Dec",
day="19",
volume="3",
number="4",
pages="e97",
keywords="papillomavirus vaccines",
keywords="immunization programs",
keywords="uterine cervical neoplasms",
keywords="newspapers as topic",
keywords="mass media",
keywords="data mining",
keywords="Japan",
abstract="Background: Media coverage and reports have a major influence on individual vaccination and other health-related activities. People use the media to seek information and knowledge on health-related behaviors. They obtain health-related information from media such as television and newspapers, and they trust such information. While several studies have examined the relation between media coverage and individual health, there is a lack of studies that have analyzed media reports of health information. In particular, we have found no analyses related to cervical cancer (human papillomavirus [HPV]) vaccine. Objective: This study aimed to identify mentions of cervical cancer vaccine in Japan's printed news media and to determine their characteristics. Methods: We used the archival databases of 2 Japanese newspapers, Yomiuri Shimbun (Yomidasu Rekishikan) and Asahi Shimbun (Kikuzo II Visual), for text mining. First, we created a database by extracting articles published between January 1, 2007, and December 31, 2014, that matched the terms ``cervical cancer'' AND ``vaccination'' in a keyword search. Then, we tallied the extracted articles based on the month of publication and number of characters in order to conduct a time-series analysis. Results: We extracted a total of 219 articles. Of these, 154 (70.3\%) were positive and 51 (23.3\%) were negative toward HPV vaccination. Of the 51 negative articles, 4 (7.8\%) were published before June 2013, when routine vaccination was temporarily discontinued due to concerns regarding side effects, and 47 (92.2\%) were published since then. The negative reports commonly cited side effects, although prior to June 2013, these issues were hardly mentioned. Although foreign media reports mentioned side effects before routine vaccination was temporarily discontinued, fewer articles mentioned side effects than recommendations for vaccination. Furthermore, on June 13, 2013, the World Health Organization's advisory body Global Advisory Committee on Vaccine Safety issued a statement regarding the safety of HPV vaccines, but hardly any articles reported this statement. Rather, several articles were published about the side effects after June 2013. Conclusions: Since we consider media coverage to be a factor affecting human health behavior, the media should extensively report on the cost of not receiving cervical cancer vaccination, global trends concerning cervical cancer vaccination, and statements released by various agencies on the subject. ",
doi="10.2196/publichealth.8237",
url="http://publichealth.jmir.org/2017/4/e97/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29258972"
}


@Article{info:doi/10.2196/jmir.7449,
author="Pot, Mirjam
and Paulussen, GWM Theo
and Ruiter, AC Robert
and Eekhout, Iris
and de Melker, E. Hester
and Spoelstra, EA Maxine
and van Keulen, M. Hilde",
title="Effectiveness of a Web-Based Tailored Intervention With Virtual Assistants Promoting the Acceptability of HPV Vaccination Among Mothers of Invited Girls: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="Sep",
day="06",
volume="19",
number="9",
pages="e312",
keywords="vaccination",
keywords="health promotion",
keywords="web-based intervention computer-tailoring",
keywords="randomized controlled trial",
abstract="Background: In 2010, the human papillomavirus (HPV) vaccination was introduced in the Dutch National Immunization Program for 12-year-old girls, aiming to reduce the incidence of cervical cancer in women. HPV vaccination uptake turned out to be lower than expected: 61\% versus 70\%, respectively. Mothers were shown to play the most important role in the immunization decision about this vaccination. They had also expressed their need for interactive personal information about the HPV vaccination over and above the existing universal general information. To improve the effectiveness of the existing education about the HPV vaccination, we systematically developed a Web-based tailored intervention with virtual assistants providing mothers of girls to be invited with tailored feedback on their decision making about the HPV vaccination. Objective: The aim of this study was to evaluate the effectiveness of the Web-based tailored intervention for promoting HPV vaccination acceptance by means of a randomized controlled trial (RCT). Methods: Mothers were recruited via the Dutch vaccination register (Praeventis) (n=36,000) and three Web-based panels (n=2483). Those who gave informed consent (N=8062) were randomly assigned to the control (n=4067) or intervention condition (n=3995). HPV vaccination uptake, as registered by Praeventis once the HPV vaccination round was completed, was used as the primary outcome. Secondary outcomes were differential scores across conditions between baseline (before the provided access to the new tailored intervention) and follow-up (just before the first vaccination) regarding the mothers' degree of informed decision making (IDM), decisional conflict, and critical determinants of HPV vaccination uptake among which are intention, attitude, risk perception, and outcome beliefs. Results: Intention-to-treat analysis (N=8062) showed a significant positive effect of the intervention on IDM, decisional conflict, and nearly all determinants of HPV vaccination uptake (P<.001). No effect was found on uptake (P=.60). This may be attributed to the overall high uptake rates in both conditions. Mothers evaluated the intervention as highly positive, including the website as well as the virtual assistants that were used to deliver the tailored feedback. Conclusions: This computer-tailored intervention has the potential to improve HPV vaccination acceptability and IDM and to decrease decisional conflict among mothers of invited girls. Implications for future research are discussed. Trial Registration: Trialregister.nl NTR4935; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4935 (Archived by WebCite at http://www.webcitation.org/6srT7l9EM) ",
doi="10.2196/jmir.7449",
url="http://www.jmir.org/2017/9/e312/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28877862"
}


@Article{info:doi/10.2196/cancer.7345,
author="Warner, L. Echo
and Ding, Qian
and Pappas, Lisa
and Bodson, Julia
and Fowler, Brynn
and Mooney, Ryan
and Kirchhoff, C. Anne
and Kepka, Deanna",
title="Health Care Providers' Knowledge of HPV Vaccination, Barriers, and Strategies in a State With Low HPV Vaccine Receipt: Mixed-Methods Study",
journal="JMIR Cancer",
year="2017",
month="Aug",
day="11",
volume="3",
number="2",
pages="e12",
keywords="health care provider",
keywords="human papillomavirus",
keywords="human papillomavirus vaccine",
keywords="mixed methods",
keywords="knowledge",
abstract="Background: Human papillomavirus (HPV) vaccination is below national goals in the United States. Health care providers are at the forefront of improving vaccination in the United States, given their close interactions with patients and parents. Objective: The objective of this study was to assess the associations between demographic and practice characteristics of the health care providers with the knowledge of HPV vaccination and HPV vaccine guidelines. Furthermore, our aim was to contextualize the providers' perceptions of barriers to HPV vaccination and strategies for improving vaccination in a state with low HPV vaccine receipt. Methods: In this mixed-methods study, participating providers (N=254) were recruited from statewide pediatric, family medicine, and nursing organizations in Utah. Participants completed a Web-based survey of demographics, practice characteristics, HPV vaccine knowledge (?10 correct vs 11-12 correct answers), and knowledge of HPV vaccine guidelines (correct vs incorrect). Demographic and practice characteristics were compared using chi-square and Fisher exact tests for HPV knowledge outcomes. Four open-ended questions pertaining to the barriers and strategies for improving HPV vaccination were content analyzed. Results: Family practice providers (52.2\%, 71/136; P=.001), institutional or university clinics (54.0\%, 20/37; P=.001), and busier clinics seeing 20 to 29 patients per day (50.0\%, 28/56; P=.04) had the highest proportion of respondents with high HPV vaccination knowledge. Older providers aged 40 to 49 years (85.1\%, 57/67; P=.04) and those who were a Vaccines for Children provider (78.7\%, 133/169; P=.03) had the highest proportion of respondents with high knowledge of HPV vaccine recommendations. Providers perceived the lack of parental education to be the main barrier to HPV vaccination. They endorsed stronger, consistent, and more direct provider recommendations for HPV vaccination delivered to parents through printed materials available in clinical settings and public health campaigns. Hesitancy to recommend the HPV vaccine to patients persisted among some providers. Conclusions: Providers require support to eliminate barriers to recommending HPV vaccination in clinical settings. Additionally, providers endorsed the need for parental educational materials and instructions on framing HPV vaccination as a priority cancer prevention mechanism for all adolescents. ",
doi="10.2196/cancer.7345",
url="http://cancer.jmir.org/2017/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28801303"
}